Castelli P, Hamard P, Benrabah R, Guillaume J B, Amarenco P, Hamard H
Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris.
J Fr Ophtalmol. 1994;17(4):252-6.
Three cases of ocular myasthenia gravis were observed. The first patient, a 74-year-old man was found to have complete left ophthalmoplegia and ptosis unchanged at examination on month after onset. The second patient, a 42-year-old man, developed incomplete right ophthalmoplegia with pseudoanterior internuclearis ophthalmoplegia, then ptosis two days later. The third patient, a 70-year-old man, presented with sudden onset complete right palsy of the third nerve. Diabetes mellitus or intra-cranial lesions were suspected in all three patients although laboratory tests, tomodensitometry, nuclear magnetic resonance imaging, or arteriography gave no confirmation. Ptosis was relieved and eye movement was improved after the intravenous edrophonium test, but electromyography was negative. The three patients were treated with anticholinesterase agents and showed unequivocal improvement. The second patient underwent thymectomy. Clinicians should inform patients of the contraindications of drugs in this disease. The diagnosis of pure oculomotor forms of myasthenia gravis is sometimes difficult to establish and should be suspected in cases of unexplained oculomotor palsy.
观察到3例眼肌型重症肌无力患者。首例患者为一名74岁男性，发病1个月后检查发现有完全性左动眼神经麻痹和上睑下垂，症状无变化。第二例患者为一名42岁男性，出现不完全性右动眼神经麻痹伴假性前核间性眼肌麻痹，2天后出现上睑下垂。第三例患者为一名70岁男性，突然出现完全性右动眼神经麻痹。尽管实验室检查、计算机断层扫描、核磁共振成像或血管造影均未证实，但所有3例患者均怀疑患有糖尿病或颅内病变。静脉注射依酚氯铵试验后，上睑下垂缓解，眼球运动改善，但肌电图检查为阴性。这3例患者均接受抗胆碱酯酶药物治疗，病情有明确改善。第二例患者接受了胸腺切除术。临床医生应告知患者本病用药的禁忌证。纯动眼神经型重症肌无力的诊断有时难以确立，对于不明原因的动眼神经麻痹病例应怀疑此病。
