Amris K, Klausen T
Fysiurgisk/reumatologisk afdeling, Københavns Amts Sygehus i Glostrup.
Ugeskr Laeger. 1993 Feb 1;155(5):320-3.
Oculomotor nerve paresis is a rare neurological manifestation in rheumatological disease. It is most commonly described in connection with systemic vascular disease such as polyarteritis nodosa, Wegener's granulomatosis and Behçet's disease but is rarely an isolated symptom. As in benign vascular and diabetic oculomotor paresis, the etiology of oculomotor paresis in rheumatic disease appears to be angiopathy and subsequent ischaemia in the nerve tissue. Two case histories are presented. Both of the patients had been recognized as having well-defined rheumatological complaints without previous neurological manifestations. Both developed partial isolated affection of the oculomotor nerve with paresis of the levator palphebrae muscle and ptosis. The condition was interpreted as mononeuritis of vascular origin and the patients were treated with methylprednisolone parenterally (1 g methylprednisolone per 250 ml isotonic sodium chloride per 24 hours for a total of three days). In the subsequent discussion, the neuroanatomical relationships of the oculomotor nuclear complex in the mesencephalon are described together with the fasciculi and the course of the peripheral nerve. On the basis of selected case histories, the possible anatomical localization of the lesion in oculomotor paresis of vascular origin is discussed.
动眼神经麻痹是风湿病中一种罕见的神经学表现。它最常与系统性血管疾病相关，如结节性多动脉炎、韦格纳肉芽肿病和白塞病，但很少作为孤立症状出现。与良性血管性和糖尿病性动眼神经麻痹一样，风湿病中动眼神经麻痹的病因似乎是血管病变及随后的神经组织缺血。本文介绍了两个病例。两名患者之前均无神经学表现，且均被诊断患有明确的风湿病。两人均出现动眼神经部分孤立性病变，伴有提上睑肌麻痹和上睑下垂。该病症被解释为血管源性单神经炎，患者接受了甲泼尼龙静脉注射治疗（每24小时在250毫升等渗氯化钠中加入1克甲泼尼龙，共三天）。在随后的讨论中，描述了中脑动眼神经核复合体的神经解剖关系以及束状结构和周围神经的走行。基于选定的病例，讨论了血管源性动眼神经麻痹中病变可能的解剖定位。
