Fujioka T, Segawa F, Ogawa K, Kurihara T, Kinoshita M
Fourth Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan.
Clin Neurol Neurosurg. 1995 May;97(2):167-71. doi: 10.1016/0303-8467(95)00012-9.
Two patients with diabetes mellitus, one of them with an isolated third cranial nerve palsy and the other with an isolated sixth cranial nerve palsy, are presented. MRI investigations including diffusion-weighted MRI revealed a small ischemic brain stem lesion in the former and a small hemorrhagic brain stem lesion in the latter. In the former case wallerian degeneration of the nerve fascicle within the mesencephalon was also detected. These cases indicate that vascular accidents of the brain stem may masquerade as fascicular or infranuclear disturbance of the oculomotor or abducens nerve; therefore, it is important to include brain stem lesions into the differential diagnosis of isolated ophthalmoplegia. Thorough investigation by MRI including diffusion-weighted MRI is helpful for correct diagnosis.
本文报告了两名糖尿病患者，其中一名患有孤立性动眼神经麻痹，另一名患有孤立性展神经麻痹。包括弥散加权磁共振成像（MRI）在内的MRI检查显示，前者脑干有一个小的缺血性病变，后者脑干有一个小的出血性病变。在前一例中，还检测到中脑内神经束的华勒氏变性。这些病例表明，脑干血管意外可能伪装成动眼神经或展神经的束性或核下性障碍；因此，在孤立性眼肌麻痹的鉴别诊断中纳入脑干病变很重要。包括弥散加权MRI在内的MRI全面检查有助于正确诊断。
