Hattori S, Utsunomiya K
Third Department of Internal Medicine, Jikei University School of Medicine.
Rinsho Shinkeigaku. 1994 Oct;34(10):1021-5.
A 62-year-old man with a history of diabetes mellitus, hypertension and liver damage has sudden diplopia on Nov. 4, 1992. Ocular movements of this right eye were normal, but his left eyelid was completely ptotic, and left pupil was dilated and nonreactive to light. In primary position, his left eye deviated outward, and could not move to any direction. He was diagnosed as having total oculomotor nerve palsy of the left side without any other neurological signs or symptoms; his consciousness level was alert and mental state was normal. The present case showed normal facial sensation, no facial palsy and no tongue deviation. Deep tendon reflexes were hypoactive bilaterally. Pyramidal tract sign, cerebellar sign, and gait disturbance were not observed. Superficial sensation of the extremity was normal. Brain CT scan revealed a small mesencephalic hemorrhage extending to the tegmentusm ventral to the cerebral aqueduct of the left side. Brain magnetic resonance imaging demonstrated a high-intensity area in the left oculomotor nucleus and its fascicles in the midbrain on T1- and T2-weighted image. The oculomotor nerve palsy of the left eye gradually improved, but mydriasis, adduction impairment and downward gaze palsy continued, and oculomotor nerve palsy of the left eye was compatible with so-called inferior branch palsy of the oculomotor nerve. Moreover, contralateral eye movements were normal except for mild upward gaze palsy. Oculomotor nerve palsy of this type was consistent with the syndrome of oculomotor nucleus described by Pierrot-Deseillingny in 1981. It was presumed that the superior rectus muscle is innervated by the contralateral oculomotor nerve nucleus in man as well as in animals.
一名62岁男性，有糖尿病、高血压和肝损伤病史，于1992年11月4日突然出现复视。右眼眼球运动正常，但左侧眼睑完全下垂，左侧瞳孔散大且对光无反应。在第一眼位时，左眼向外偏斜，不能向任何方向运动。他被诊断为左侧动眼神经完全麻痹，无任何其他神经体征或症状；意识水平清醒，精神状态正常。本例患者面部感觉正常，无面瘫，无舌偏斜。双侧腱反射减弱。未观察到锥体束征、小脑征和步态障碍。肢体浅感觉正常。脑部CT扫描显示左侧中脑出血，血肿延伸至中脑导水管腹侧的被盖部。脑部磁共振成像显示在T1加权像和T2加权像上，左侧动眼神经核及其在中脑的神经束呈高信号区。左眼动眼神经麻痹逐渐改善，但瞳孔散大、内收障碍和向下凝视麻痹持续存在，左眼动眼神经麻痹符合所谓的动眼神经下支麻痹。此外，除轻度向上凝视麻痹外，对侧眼球运动正常。这种类型的动眼神经麻痹与1981年Pierrot - Deseillingny描述的动眼神经核综合征一致。据推测，在人类和动物中，上直肌均由对侧动眼神经核支配。
