外展神經(jīng)麻痹-2017

1、外展神經(jīng)麻痹 Abducens Nerve Palsy,陳錦瓊,外展神經(jīng)麻痹的解剖,2,,外展神經(jīng)麻痹的解剖,3,,Neurosurgery 61:ONS-7–ONS-14, 2007,外展神經(jīng)麻痹的流行病學,年發(fā)病率11.3/100,000 在一組4278 例獲得性眼外肌顱神經(jīng)病變中， CN VI 43.8%, CN III 28% ， CN IV 15%,4,外展神經(jīng)麻痹的病因,微血管缺血病變 microvascular

2、ischemic disease50%（主要見于糖尿病及高血壓患者） 外傷 炎癥性 占位病變 顱壓升高 多發(fā)性硬化 腰穿或脊髓麻醉 卒中 先天性,5,外展神經(jīng)麻痹的病因,6,Chi Sulene L,Bhatti M Tariq. The diagnostic dilemma of neuro-imaging in acute isolated sixth nerve palsy.[J] .Curr Opin Oph

3、thalmol, 2009, 20(6): 423-9.,外展神經(jīng)麻痹的臨床表現(xiàn),癥狀： 復視 ，常合并有眶周疼痛 體征：原位內(nèi)斜，向外側(cè)注視增大；部分或全部外展缺陷；向麻痹側(cè)方向的眼掃視運動減慢,7,外展神經(jīng)麻痹的影像學,對于非孤立性年齡低于50歲既往腫瘤史沒有微血管病風險因素 建議頭顱MRI增強 也有作者建議所有患者完善頭顱MRI增強,8,Elder Christopher,Ha

4、inline Clotilde,Galetta Steven L et al. Isolated Abducens Nerve Palsy: Update on Evaluation and Diagnosis.[J] .Curr Neurol Neurosci Rep, 2016, 16(8): 69.,外展神經(jīng)麻痹的影像學,9,Elder Christopher,Hainline Clotilde,Galetta Steven L

5、et al. Isolated Abducens Nerve Palsy: Update on Evaluation and Diagnosis.[J] .Curr Neurol Neurosci Rep, 2016, 16(8): 69.,外展神經(jīng)麻痹的鑒別診斷,重癥肌無力 甲狀腺相關(guān)眼病 先天性眼肌麻痹、Duane眼球后退綜合征會聚痙攣,10,Elder Christopher,Hainline Clotilde,Galett

6、a Steven L et al. Isolated Abducens Nerve Palsy: Update on Evaluation and Diagnosis.[J] .Curr Neurol Neurosci Rep, 2016, 16(8): 69.,外展神經(jīng)麻痹的治療,治療取決于病因孤立性的血管性的外展神經(jīng)麻痹，控制危險因素可能預防疾病的復發(fā)，但不能加快緩解速度,11,Elder Christopher,Hainlin

7、e Clotilde,Galetta Steven L et al. Isolated Abducens Nerve Palsy: Update on Evaluation and Diagnosis.[J] .Curr Neurol Neurosci Rep, 2016, 16(8): 69.,外展神經(jīng)麻痹的預后,孤立性麻痹：73 %完全恢復外傷性： 88 % 血管性： 62 % 腫瘤性或動脈瘤：40%,12,Elder Chr

8、istopher,Hainline Clotilde,Galetta Steven L et al. Isolated Abducens Nerve Palsy: Update on Evaluation and Diagnosis.[J] .Curr Neurol Neurosci Rep, 2016, 16(8): 69.,糖尿病性眼肌麻痹,糖尿病性眼肌麻痹發(fā)生率：0.32 %, 53.11 %, 36.36 %, 2.8 % f

9、or cranial nerves VI, III, IV主要見于2型糖尿病最重要的 危險因素：≥45 歲，糖尿病病程≥ 10 年，男性，存在糖尿病視網(wǎng)膜病變及腎臟病變 治療：控制血糖及危險因素,13,Al Kahtani Eman S,Khandekar Rajiv,Al-Rubeaan Khalid et al. Assessment of the prevalence and risk factors of ophthalm