OCULOMOTOR PALSY IN DIABETES MELLITUS - A CLINICO-PATHOLOGICAL STUDY
OCULOMOTOR PALSY IN DIABETES MELLITUS - A CLINICO-PATHOLOGICAL STUDY
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DOI：
10.1093/brain/93.3.555
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发表时间：
1970-01-01
期刊：
影响因子：
14.5
通讯作者：
FISHER, CM
中科院分区：
文献类型：
--
作者：
ASBURY, AK;ALDREDGE, H;FISHER, CM
尽管医生们长期以来一直怀疑某些与糖尿病有关的神经病变是血管性的，但证实这一点的病理学证据却很少。Dreyfus、Hakim和亚当斯（1957）报道了一例近期第三神经麻痹的尸检病例，其主要病理发现是神经海绵体内部分的髓鞘和轴突破坏的局灶性区域，伴梭形扩大和结缔组织增加。在其广泛的连续切片中未发现血管闭塞;然而，他们根据组织病理学特征得出结论，病变起源于缺血;他们还假设负责的血管疾病最有可能是远离神经的营养血管闭塞。Raff等人（1968）在另一项连续切片研究中显示，在这种近端、不对称、主要是运动神经病的情况下，受影响的神经干布满了小梗死。一个单一的闭塞神经内动脉似乎占三个梗死的30个连续研究，但没有其他闭塞的血管可以找到其他27个病变。发现一种更细微的血管变化与梗死区域更密切相关，即具有壁内PAS阳性物质和管腔狭窄的小动脉和毛细血管壁增厚和血管化。基于这种累积的经验，有人认为近端、不对称、主要为运动神经病和颅单神经病都是血管源性的，应被认为是缺血性单神经病或与糖尿病相关的多发性单神经病（Raff和阿斯伯里，1968）。
ALTHOUGH physicians have long suspected that certain neuropathies occurring in association with diabetes mellitus were" vascular" in origin, pathological evidence to substantiate this point has been meagre. Dreyfus, Hakim and Adams (1957) reported an autopsied case of recent third nerve palsy, the major pathological finding of which was a focal zone of myelin sheath and axon destruction in the intracavernous portion of the nerve with fusiform enlargement and an increase in connective tissue. An occluded vessel was not found in their extensive serial sections; however, they concluded, on the basis of the histopathological characteristics, that the lesion was ischaemic in origin; they also postulated that the responsible vascular disorder was most likely an occluded nutrient vessel remote from the nerve. Raff et al.(1968) showed in another serial section study, in this instance of a proximal, asymmetrical, primarily motor neuropathy, that the affected nerve trunks were studded with small infarcts. A single occluded intraneural artery seemed to account for three infarcts out of the thirty studied serially, but no other occluded vessels could be found to account for the other twenty-seven lesions. A more subtle vascular change was found to relate more closely with areas of infarction, namely thickening and Tiyalinizatiori of arteriolar and capillary waHs with intramural PAS-positive material and luminal narrowing. On the basis of this cumulative" experience, it has been suggested that both the proximal, asymmetrical, primarily motor neuropathy and the cranial mononeuropathy are vascular in origin, and should be thought of as ischaemic mononeuropathy or mononeuropathy multiplex in association with diabetes mellitus (Raff and Asbury, 1968).