多发颅内动脉瘤致动眼神经麻痹1例英文版.ppt

 A case of oculomotor nerve palsy caused by multiple intracranial aneurysms 多发颅内动脉瘤致动眼神经麻痹1例 Case report Woman，65 years old headache, diplopia（复视） and right-sided ptosis（上睑下垂） for one day Ophthalmoplegia 眼肌麻痹 Past medical history： Cervical spondylosis（颈椎病） Examination VAod：0.8，VAos：0.6，BCVAou：1.0 IOP：od 14mmHg，os 15mmHg right ptosis, diplopia, and dilated pupil Oculomotor nerve palsy（ONP） Complete ONP Artery aneurysm ？ 动眼神经解剖 Aneurysm and vascular disease can be differentiated clinically Diagonosis: artery aneurysm Suggestion: Magnetic resonance angiography aneurysm in the right posterior communicating artery (PcomA) aneurysm in the carotid （颈动脉）cavernous segment Treatment An urgent operation： DSA + coil embolization of bilateral artery aneurysms Diagonosis of post-operation： 1.Subarachnoid hemorrhage（蛛网膜下腔出血） 2.Aneurysm of PcomA 3.Aneurysm of carotid cavernous segment 4.Oculomotor nerve palsy Results The ONP with pupil involvement was completely resolved within two months after surgery ONP completely recovered Preoperative：ONP Discuss ONP is a common initial symptom and in some cases the only neurological deficit in patients with PcomA aneurysms The sufferers are usually in such severe pain in the ipsilateral（身体同侧的） forehead Involvement or sparing of the pupil is often considered to be the most important diagnostic criterion. Discuss-reasons of ONP ONP that spares the pupil is usually attributed to microvascular ischemia, diabetes or hypertension Conversely, pupil paresis indicates compression by tumors and aneurysms, which requires neuroradiological evaluation and, occasionally, surgical intervention pupil ptosis, diplopia, ophthalmoplegia + - microvascular ischemia： diabetes or hypertension compression： tumors and aneurysms Discuss-examination MRA（ Magnetic Resonance Angiography）磁共振血管成像：sensitivity of aneurysm is 89% DSA（Digital Subtraction Angiography）数字减影血管造影：gold standard，invasive?test The internal caroti