內頸動脈－後交通動脈瘤合併瞳孔正常之動眼神經麻痺－病例報告

Pupil-Sparing Oculomotor Palsy with Internal Carotid-Posterior Communicating Artery Aneurysm

吳東隆(Dung-Lung Wu) ； 程維璋(Wei-Chang Cheng) ； 朱炤廉(Chao-Lein Chu) ； 周秉義(Ping-I Chou)

《中華民國眼科醫學會雜誌》 35卷2期 (1996/06) Pp. 231-234

https://doi.org/10.30048/ACTASOS.199606.0018

摘要

在一般的動脈瘤所造成的動眼神經麻痺患者，虹膜括約肌幾乎不可避免地受到影響，使得瞳孔擴大或對光反射遲鈍。甚至有人說如果是單獨的動眼神經麻痺，而瞳孔大小反射正常可以排除動脈瘤的可能。在此我們發現一例因為後交通動脈瘤造成的動眼神經麻痺，但是發病初期瞳孔卻仍然正常，經腦血管攝影及手術結果證實為後交通動脈瘤破裂合併蜘蛛網膜下腔出血。所以瞳孔正常的動眼神經麻痺不能排除後交通動脈瘤的可能，即使病人已有糖尿病的病史。腦血管動脈攝影檢查是最佳診斷工具，由眼科醫師發現的動眼神經麻痺患者不少，約佔所有病例的18%~40%，眼科醫師要特別注意。

並列摘要

Many have stressed the importance of pupillary dysfunction for differentiating between aneurysmal & diabetic oculomotor palsy, in the latter whose pupillary function is usually normal. We present a well-documented example of pupil-sparing oculomotor palsy caused by an ICA-PoCA junction aneurysm. We report this case to emphasize that pupil-sparing oculomotor palsy cannot exclude the possibility of aneurysm. The oculomotor palsies presented to ophthalmogist are among 18% (Rucker, 1966) to 40% (Balla & Morley, 1967). We should follow up the change of pupils closely at least for one week. If the pupil dilate under observation or pain continues unabated, or both, we recommend angiography to verify the possibility of intracranial aneurysm.

並列關鍵字

intracranial aneurysm ； oculomotor palsy ； pupillary sparing