- 期刊
Wrong-Way Eyes in Thalamic Hemorrhage: A Case Report and Literature Review
急性視丘出血併動眼錯誤偏向：一病例報告及文獻分析
摘要
Background: Wrong-way eyes represents a neurological phenomenon that causes the eyes to look toward the contralateral side of the supratentorial lesion. Here, we reported one case with acute left thalamic hemorrhage and clinical manifestation of wrong-way eyes. Case report: A 78-year-old man with hypertension and end-stage renal disease presented with acute onset unresponsiveness and prominent right side limbs weakness. Preferential gaze to the right side was noted at the initial presentation. Non-contrast brain CT showed left thalamic hemorrhage around 25 ml with midline shift and intraventricular hemorrhage. In the next 24 to 48 hours after onset, his neurological state deteriorated gradually, with drowsier consciousness, global aphasia, and failed to sustain antigravity over all the extremities. Meanwhile, intermittent preferential gaze to the right side and slightly downward was still observed. Follow-up brain CT showed stationary hematoma size and midline shift distance, without obvious hydrocephalus or brain herniation. Electroencephalographic study showed no evidence of epileptiform discharges. He remained stationary semi-comatose state on the time of discharge. Conclusion: Although uncommon, wrong way eyes could appear in patients with thalamic hemorrhage and may imply a poor neurological outcome.
並列摘要
背景：動眼錯誤偏向（wrong-way eyes）為一天幕上病灶區域造成眼球偏向病灶對側之神經學徵象。此病例報告呈現一因左側視丘急性出血所導致之動眼錯誤偏向之個案及相關文獻分析。病例報告：78歲男性被診斷高血壓及末期腎病變，呈現突發意識狀態變化、右側肢體無力及雙眼右側偏移。腦部電腦斷層影像顯示左側視丘出血約25毫升，合併中線偏移及腦室內出血。病人之初始神經學症狀於24至48小時内逐漸惡化，意識狀態昏迷、完全性失語症及四肢肌肉張力減弱，且仍可見陣發性雙眼右側偏移。追蹤之腦部電腦斷層影像顯示血塊體積及中線偏移程度穩定，無明顯水腦症或腦疝。腦波檢查顯示瀰漫性背景慢波，未發現明確癲癇樣放電。病人整體神經學狀態於48小時後未再有明顯改善或起伏，於出院時意識狀態仍呈現昏迷。結論：動眼錯誤偏向為腦中風後少見之神經學表徵，可表現於視丘之出血性病灶，並常伴隨神經學症狀的惡化及暗示較不佳的預後。