Biousse V, Touboul P J, D'Anglejan-Chatillon J, Lévy C, Schaison M, Bousser M G
Department of Neurology, Lariboisière Hospital, Paris, France.
Am J Ophthalmol. 1998 Oct;126(4):565-77. doi: 10.1016/s0002-9394(98)00136-6.
To report the ophthalmologic symptoms and signs associated with extracranial internal carotid artery dissection.
One hundred forty-six consecutive patients with extracranial internal carotid artery dissection were evaluted; 29 were studied retrospectively from 1972 to 1984 and 117 prospectively from 1985 to 1997.
Sixty-two percent of patients (91/146) with extracranial internal carotid artery dissection had ophthalmologic symptoms or signs that were the presenting symptoms or signs of dissection in 52% (76/146). Forty-four percent (65/146) had painful Horner syndrome, which remained isolated in half the cases (32/65). Twenty-eight percent (41/146) had transient monocular visual loss, which was painful in 31 cases, associated with Horner syndrome in 13 cases, and described as "scintillations" or "flashing lights"-often related to postural changes or exposure to bright lights-suggesting acute choroidal hypoperfusion in 23 cases. Four patients had ischemic optic neuropathy; one had diplopia. Among the 76 patients with ophthalmologic symptoms or signs as the presenting features of carotid dissection, a nonreversible ocular or hemispheric stroke later occurred in 27, within a mean of 6.2 days (range, 1 hour to 31 days). Eighteen patients had a stroke within the first week after the onset of neuro-ophthalmic symptoms and signs, and 24 had a stroke within the first 2 weeks.
Ophthalmologic symptoms or signs are frequently associated with and are often the presenting features in internal carotid artery dissection. Painful Horner syndrome or transient monocular visual loss should prompt investigations to diagnose carotid artery dissection and begin early treatment to prevent a devastating ocular or hemispheric stroke.
报告与颅外颈内动脉夹层相关的眼科症状和体征。
对146例连续的颅外颈内动脉夹层患者进行评估；其中29例为1972年至1984年的回顾性研究，117例为1985年至1997年的前瞻性研究。
62%（91/146）的颅外颈内动脉夹层患者有眼科症状或体征，其中52%（76/146）为夹层的首发症状或体征。44%（65/146）有疼痛性霍纳综合征，其中半数（32/65）为孤立性。28%（41/146）有短暂性单眼视力丧失，其中31例伴有疼痛，13例与霍纳综合征相关，23例描述为“闪烁”或“闪光”——通常与体位改变或暴露于强光有关，提示急性脉络膜灌注不足。4例有缺血性视神经病变；1例有复视。在76例以眼科症状或体征为颈动脉夹层首发特征的患者中，27例随后发生了不可逆的眼部或半球性卒中，平均发生时间为6.2天（范围1小时至31天）。18例在神经眼科症状和体征出现后的第一周内发生卒中，24例在最初2周内发生卒中。
眼科症状或体征常与颈内动脉夹层相关，且常为首发特征。疼痛性霍纳综合征或短暂性单眼视力丧失应促使进行检查以诊断颈动脉夹层，并尽早开始治疗以预防严重的眼部或半球性卒中。
