Ueda M, Takeuchi M, Ota K, Uchiyama S, Iwata M
Department of Neurology, Tokyo Women's Medical College.
Rinsho Shinkeigaku. 1997 Nov;37(11):1021-3.
We report a 62-year-old woman who was admitted to our hospital because of abrupt onset of ptosis, and alternating and recurrent bilateral external ophthalmoplegia in a short period without pupillary sphincter muscle abnormality. She had been suffering from uveitis of unknown origin for four years before admission, which was improved with the local administration of steroid. Her brain CT and MRI showed a parasellar mass lesion, and cerebral angiography revealed total occlusion of the right internal carotid artery with little arteriosclerotic change in other blood vessels. She was diagnosed as having sarcoidosis because of elevated serum creatinine kinase and lysozyme levels, and the pathological finding of granuloma in muscle biopsy. The oral administration of prednisolone resulted in disappearance of her external ophthalmoplegia completely in ten months. We postulate that in this patient, the alternating and recurrent external ophthalmoplegia in a short period was related to ischemic neuropathy caused by vascular lesion of neurosarcoidosis.
我们报告一位62岁女性，因突然出现上睑下垂，短期内双侧交替性、复发性眼球外肌麻痹，且无瞳孔括约肌异常而入住我院。入院前4年，她一直患有病因不明的葡萄膜炎，经局部应用类固醇后病情有所改善。她的脑部CT和MRI显示鞍旁有占位性病变，脑血管造影显示右侧颈内动脉完全闭塞，其他血管几乎无动脉硬化改变。由于血清肌酸激酶和溶菌酶水平升高，以及肌肉活检发现肉芽肿，她被诊断为结节病。口服泼尼松龙10个月后，她的眼球外肌麻痹完全消失。我们推测，该患者短期内交替性、复发性眼球外肌麻痹与神经结节病血管病变导致的缺血性神经病变有关。
