Ono Y, Umeda F, Nawata H, Hisatomi A, Takano S, Hara Y, Kaneko Y, Matsunaga M
Third Department of Internal Medicine, Faculty of Medicine Kyushu University, Fukuoka.
Fukuoka Igaku Zasshi. 1993 Nov;84(11):488-92.
Partial ophthalmoplegia due to third nerve palsy with an intact pupil is a frequent cause of diploplia observed in diabetic patients. Pupillary muscle involvement, such as anisocoria and loss of light reflex, is usually uncommon in this diabetic cranial mononeuropathy. A 65-year-old woman with non-insulin dependent diabetes mellitus (NIDDM) suddenly developed a severe headache and diplopla. Right oculomotor nerve palsy was observed in association with anisocoria, ptosis of the right lid, and a defective light reflex. No exophthalmos or vascular bruit was observed in the right orbital region. Computed tomography and magnetic resonance images of the head were negative. Cerebral angiography revealed a carotid cavernous sinus fistula (CCF). The patient was successfully treated with external carotid artery embolization combined with radiation. It is well known that pupil sparing in oculomotor nerve palsy predicts an extraaxial ischemic lesion, while pupil involvement predicts an extraaxial compression lesion. Therefore, pupillary involvement in oculomotor nerve palsy in diabetic patients necessitates cerebrovascular investigation to rule out ICPC aneurysm or tumor. In this circumstance, a variant type of CCF without characteristic ocular signs should be included in the differential diagnosis.
糖尿病患者中，由动眼神经麻痹导致的部分眼肌麻痹且瞳孔完好是复视的常见原因。在这种糖尿病性颅单神经病中，瞳孔肌受累，如瞳孔不等大和光反射丧失，通常并不常见。一名65岁非胰岛素依赖型糖尿病（NIDDM）女性突然出现严重头痛和复视。观察到右侧动眼神经麻痹，伴有瞳孔不等大、右侧眼睑下垂和光反射缺陷。右侧眼眶区域未观察到眼球突出或血管杂音。头部计算机断层扫描和磁共振成像均为阴性。脑血管造影显示为颈内动脉海绵窦瘘（CCF）。该患者通过颈外动脉栓塞联合放疗成功治愈。众所周知，动眼神经麻痹时瞳孔未受累提示轴外缺血性病变，而瞳孔受累提示轴外压迫性病变。因此，糖尿病患者动眼神经麻痹时瞳孔受累需要进行脑血管检查以排除颈内动脉后交通动脉瘤或肿瘤。在这种情况下，鉴别诊断应包括一种无典型眼部体征的CCF变异型。
