45例颅内动脉瘤患者神经眼科表现观察

摘要

目的 观察颅内动脉瘤患者神经眼科表现.方法 临床检查确诊的颅内动脉瘤患者169例中有神经眼科表现的45例患者纳入研究.患者中男性18例,女性27例.平均年龄(56.21±16.11)岁.其中,50岁以上者32例,占71.11％.出现症状至就诊时间30 min～20年.其中,24 h内就诊20例,占44.44％.均单独或联合行头颅CT、CT血管造影、MRI、MRI血管造影、脑血管数字减影造影检查,以及视力、瞳孔光反射和眼球运动检查.回顾分析患者首发表现、神经眼科症状及体征、影像学检查结果、治疗及预后.结果 有神经眼科表现的颅内动脉瘤患者占同期颅内动脉瘤患者的26.63％.其中,以眼部症状、体征为首发表现者6例,占13.33％;以神经症状、体征首发表现者39例,占86.67％.有神经眼科表现的颅内动脉瘤患者的神经眼科症状主要为视力下降、复视、眼球胀痛,分别为10、4、2例,占22.22％、8.89％、4.44％.神经眼科体征中,瞳孔异常31例,占68.89％;眼球运动障碍16例,占35.56％;上睑下垂8例,占17.78％;眼球震颤2例,占4.44％;眼球突出1例,占2.22％;角膜反射消失1例,占2.22％.颅内动脉瘤破裂致颅内出血29例,占64.44％;未见颅内出血16例,占35.56％.伴或不伴颅内出血者神经眼科表现均以瞳孔异常、眼球运动障碍及视力下降最为常见.伴颅内出血者瞳孔异常发生率较不伴颅内出血者高,差异有统计学意义(x2=7.321,P=0.007).瞳孔异常、视力下降者多见于颈内动脉瘤;眼球运动障碍则以颈内动脉瘤和后交通动脉瘤常见.结论 颅内动脉瘤神经跟科表现多样,以瞳孔异常、眼球运动障碍和视力下降最为常见.%Objective To observe the neuro-ophthalmological features of intracranial aneurysm.Methods 169 patients with intracranial aneurysm were retrospectively studied.45 patients, including 18 men and 27 women, had neuro ophthalmological symptoms or signs.Their average age was (56.21 ± 16.11) years and 32 (71.11％)patients' age was more than 50 years.The onset time ranged from 30 minutes to 20 years.20 (44.44％) patients' onset time was among 24 hours.CT, CT angiography, MRI, MRI angiography and cerebral digital subtraction angiography were performed alone or combined in all 45 patients.Visual acuity, pupil reflex and eye movement were examined.Clinical data including general condition, initial symptoms, neuro-ophthalmological changes, imaging data and treatment effects were recorded.Results 26.63％ of the 169 patients had neuro-ophthalmological symptoms or signs.There were 6 patients (13.33％) with neuro ophthalmological changes as their first manifestation and 39 patients (86.67 ％) with neurologic changes as first manifestation.Neuro-ophthalmological symptoms included vision loss (10 patients, 22.22％), diplopia (4 patients, 8.89％) and ocular pain (2 patients, 4.44％).The most common neuro-ophthalmological sign was pupil abnormality which was found in 31 patients (68.89 ％).The second most common sign was eye movement disorder (16 patients, 35.56％).The other signs included ptosis (8 patients, 17.78％), nystagmus (2 patients, 4.44％), exophthalmos (1 patient, 2.22％) and disappeared corneal reflection (1 patient, 2.22％).Imaging examination indicated that intracranial hemorrhage happened in 29 patients (64.44％).The most common neuro-ophthalmological features were pupil abnormality, eye movement disorder and vision loss in both patients with or without intracranial hemorrhage.The incidence of pupil abnormality was higher in patients with intracranial hemorrhage than that without intracranial hemorrhage, the difference was statistically significant (x2=7.321, P=0.007).Pupil abnormality and vision loss were common in patients with internal carotid artery aneurysm, and eye movement disorder was common in patients with internal carotid artery aneurysm and posterior communicating aneurysms.Conclusions Patients with intracranial aneurysm have different neuroophthalmological features.The most common features are pupil abnormality, eye movement disorder and vision loss.