Chen R, Sahjpaul R, Del Maestro R F, Assis L, Young G B
Department of Clinical Neurological Sciences, University of Western Ontario, London, Canada.
J Neurol Neurosurg Psychiatry. 1994 Sep;57(9):1126-8. doi: 10.1136/jnnp.57.9.1126.
Ipsilateral third nerve palsy with early pupillary enlargement is an important sign of transtentorial herniation from a supratentorial mass lesion. A case of frontal, intraparenchymal haemorrhage is reported in which the first ocular manifestation of transtentorial herniation was enlargement of the contralateral pupil. The ipsilateral pupil dilated only after complete oculomotor palsy of the contralateral eye. After partial frontal lobectomy and removal of blood clot, the ipsilateral third nerve recovered before the contralateral third nerve. Clinical findings localised the contralateral third nerve lesion to an extra-axial site. The possible mechanisms of contralateral third nerve compression are discussed. This seems to be the first example of pupillary enlargement as a false localising sign from a contralateral, supratentorial, intraparenchymal mass lesion.
伴有早期瞳孔扩大的同侧动眼神经麻痹是幕上占位性病变导致小脑幕切迹疝的重要体征。本文报告一例额叶脑实质内出血病例，其中小脑幕切迹疝的首个眼部表现是对侧瞳孔扩大。仅在对侧眼完全动眼神经麻痹后同侧瞳孔才扩张。在部分额叶切除及清除血凝块后，同侧动眼神经比对侧动眼神经先恢复。临床发现将对侧动眼神经病变定位于轴外部位。讨论了对侧动眼神经受压的可能机制。这似乎是首例由对侧幕上脑实质内占位性病变导致瞳孔扩大作为假定位体征的病例。
