论文部分内容阅读
目的探讨神经性眼肌强直的发病原因、临床特点及诊断与治疗。方法报告神经性眼肌强直4例并结合复习相关文献,对本病的病因、诊断及治疗进行深入分析和讨论。结果例1,66岁,女性,内直肌痉挛,多年前,因垂体肿瘤接受过放疗。 痉挛发生于凝视第一眼位,并可由偏心注视引发。例2,72岁,男性,多年前接受放射性二氧化钍脊髓造影,发生慢性蛛网膜炎。偏心注视引起第三和第六神经支配的肌肉痉挛。这2例病人经卡马西平治疗,神经性眼肌强直停止。例3,47岁,男性,偏心注视时一侧直肌强直。几年前,因脑干成神经管细胞瘤接受放疗。因癫痫用卡马西平治疗,卡马西平用量减小,发生痉挛;用量增加.痉挛停止。例4,21岁,男性,颈部,头部,脑部先天性血管瘤反复发作,几年前部分摘除,上斜肌强直。向下注视引起痉挛并可自行缓解。结论神经性眼肌强直可出现干颅内病变治疗后数月到数年。典型的颅内病变的治疗是颅内肿瘤的放疗,但其它原因造成的颅内神经损伤也能引起眼肌神经性强直。由第三,四,六神经支配的眼外肌痉挛直接造成斜视和复视,持续几秒到几分钟。痉挛可自发产生,也可由偏心注视刺激相关颅神经诱发。神经放射性检查有时可显示海绵窦内或周围异常,但通常不显示原发肿瘤的复发。这种综合征极少自愈,但卡马西平治疗效果显著。
Objective To investigate the etiology, clinical features, diagnosis and treatment of neuromyotonia. Methods Report of 4 cases of neurogenic ocular ankylosis combined with the review of relevant literature on the etiology, diagnosis and treatment of in-depth analysis and discussion. Results: A 1,66-year-old female, posterior rectus spasm, many years ago, received radiotherapy for a pituitary tumor. Spasm occurs in the first gaze, and can be caused by eccentric gaze. Example 2, 72 years old, male, years ago received radioactive thoria myelography, chronic arachnoiditis. Eccentric fixation causes the third and sixth innervated muscle spasms. These 2 patients were treated with carbamazepine and neurogenic oculomotor stopped. Cases 3,47 years old, male, eccentric side of rectus muscle rigidity. A few years ago, because of brainstem medulloblastoma received radiotherapy. Due to epilepsy with carbamazepine treatment, carbamazepine dosage decreased, cramps; dosage increased. Spasticity stopped. Example 4, 21 years old, male, neck, head, brain congenital hemangioma recurrent, a few years ago, partial removal of upper oblique muscle rigidity. Gazing down causes spasticity and relieves itself. Conclusions Nervous ocular muscle rigidity may occur after several months to several years after treatment of dry intracranial lesions. The treatment of typical intracranial lesions is intracranial tumor radiotherapy, but other causes of intracranial nerve damage can also cause ocular neuromyotonia. By the third, fourth, six innervation of the external ophthalmoplegia directly cause strabismus and diplopia, for a few seconds to several minutes. Spasms can occur spontaneously, can also be induced by eccentric gaze stimulation related cranial nerves. Neurological radioactivity sometimes shows abnormalities in or around the cavernous sinus, but usually does not show the recurrence of the primary tumor. This syndrome rarely self-healing, but carbamazepine treatment effect is remarkable.