眼外肌麻痹的诊断思路.ppt

动眼神经麻痹的临床特点动眼神经麻痹可以是部分性的，表现为眼外肌不完全麻痹眼外肌完全麻痹而眼内肌正常仅眼内肌障碍--瞳孔散大，对光反射及调节反应减退或消失，眼外肌正常动眼神经核性损伤常为部分性、双侧性动眼神经自核至眶上裂这一段，其纤维紧聚一起，受损时常为完全性麻痹进入眼眶内后，动眼神经的末梢部份分散支配各眼肌，因此受损时常引起不完全麻痹01中脑缺血性病变和炎症，常为双侧和不完全性动眼麻痹，多伴脑干症状02脑疝——天幕疝时同侧动眼神经麻痹03动脉瘤——颈内动脉、颅底动脉环动脉瘤可压迫动眼神经产生症状04糖尿病——Ⅲ、Ⅳ多见，瞳孔不影响05斜坡肿瘤——双侧动眼神经麻痹动眼神经麻痹的常见病因1Nuclearandintramedullary(fasciular)2Infarction3Ddmyelination4Tumor5Trauma6WernickediseaseLesionofthethirdnerveLesionofthethirdnerveRadicular(subarachnoidspaceandtentorialedge)Aneurysm(posteriorcommunicatingorbasilar)Meningitis(infectious,neoplastic,granulomatous)DiabeticinfarctionTumorRaisedintracranialpressure(horizontalshiftandherniationofmedialtemporallobe,hydrocephalus)LesionofthethirdnerveCavernoussinusandsuperiororbitalfissureDiabeticinfarctionofnerveAneurysmofinternalcarotidarteryCarotid-cavernousfistulaCavernousthrombosis(septicandbland)Tumor(pituitary,meningioma,nasopharyngealcarcinoma,metastasis)PituitaryapoplexySphenoidsinusitisandmucoceleHerpeszosterTolosa-HuntsyndromeMacroglobulinemia-hyperviscosityOrbit1Trauma2Fungalinfection(mucormycosis,etc)3Tumorandgranuloma4Uncertainlocalization5Migraine6Postinfectious7Lesionofthethirdnerve向下看困难除上视外，各向均有复视平视时，患侧眼球位置稍偏上患眼内收时，眼球位置稍偏上头部歪向患侧时，患侧眼球位置更偏上头部歪向对侧肩部，使患侧眼球位置得以改善滑车神经麻痹的临床特点LesionofthefourthnerveNuclearandintramedullary(fascicular)MedbrainhemorrhageandinfarctionTumorArteriovenousmalformationDemyelinationRadicular(subarachnoidspace)Tumor(pineal,meningioma,metastasis,stc)HydrocephalusPseudotumorcerebriandincreasedintracranialpressureMastoiditisMeningitis(infectious,neoplastic,granulomatous)RaisedintracranialpressureLesionofthefourthnerveCavernoussinusandsuperiororbitalfissureTumorTolosa-HuntsyndromeInternalcarotidaneurys