Neurology:眶尖综合征合并脑梗死,怎么回事?

2018-01-06 杨中华 脑血管病及重症文献导读

61岁,男性。快速进展性右眼视力下降、凸眼和疼痛、上睑下垂和右侧前额麻木。


61岁,男性。快速进展性右眼视力下降、凸眼和疼痛、上睑下垂和右侧前额麻木。

既往史:冠心病,2型糖尿病,一周期糖尿病酮症酸中毒,高血压和高脂血症。

脑MRI矢状位T1(A图)显示右侧蝶窦内和斜坡局灶性低信号;轴位Flair(B图)和T1(C图)显示双侧蝶骨气房异常浊化,右侧更明显;轴位DWI显示右侧中脑(D图)和右侧分水岭区(E图)以及右侧视神经(F图)DWI高信号,提示梗死。脑TOF MRA(G图)显示右侧颈内动脉海绵窦段狭窄:



入院后内镜清创,病理显示毛霉菌感染



诊断为眶尖综合征,毛霉菌感染,脑梗死。

脑梗死的原因作者认为:毛霉菌病与缺血性卒中有关,病理生理机制为菌丝侵入动脉管腔、内膜损伤和血管炎。

原始出处:

Lamotte G,et al.Clinical Reasoning: Monocular vision loss, ophthalmoplegia, and strokes in a 61-year-old man with diabetes mellitus.Neurology. 2017 Dec 12;89(24):e276-e281. doi: 10.1212/WNL.0000000000004742.

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    2018-01-11 yinhl1978
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    2018-01-08 karmond