Arnold-Chiari malformation: improvement in eye movements after surgical treatment.
Arnold-Chiari malformation: improvement in eye movements after surgical treatment.
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Arnold-Chiari 畸形：手术治疗后眼球运动改善。
DOI：
10.1093/brain/104.1.51
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发表时间：
1981
期刊：
影响因子：
--
通讯作者：
Baloh,RW
中科院分区：
文献类型：
--
作者：
Spooner,JW;Baloh,RW
我们研究了5例Arnold-Chiari畸形患者在枕下减压前后的眼动异常。术前所有患者均有头部运动时及运动后静息时的示波及注视目标的视觉模糊。3例为下拍性眼球震颤，1例为横眼震颤，1例为横眼震颤，1例为旋转性眼球震颤。平滑追求、眼动性震颤和前庭眼震的固定抑制功能明显受损。术后2个月内，3例患者原发位置的眼球震颤消失，4例患者在随后几个月内所有注视位置的眼球震颤完全或接近完全消失。同时，示波器减少。提供显著的视觉功能改善。一名患者只有轻微的功能改善，术后7年仍有明显的眼球震颤。所有患者的平滑追求、光动性眼球震颤和前庭眼球震颤的固定抑制均有所改善，但在更高的刺激速度下没有患者完全恢复。他们仍然抱怨与头部运动相关的视觉模糊，可能是由于前庭眼球震颤的固定抑制不良。我们的研究结果表明，Arnold-Chiari畸形的眼动异常是由于小脑疝对尾侧脑干的压迫，而不是先天性的动眼神经通路异常。眼球震颤比追求或固定抑制异常更容易消退，但大多数患者在术后4个月后所有异常均逐渐改善。
We studied abnormalities of eye movement in five patients with Arnold-Chiari malformation before and after suboccipital decompression. Before operation all patients complained of oscillopsia at rest and visual blurring of fixated targets during and immediately after their heads were in motion. Three patients had downbeat nystagmus, one patient had horizontal nystagmus in the primary position and on eccentric gaze and one patient had rotatory nystagmus on lateral gaze only. Smooth pursuit, optokinetic nystagmus and fixation suppression of vestibular nystagmus were markedly impaired. Within two months after operation nystagmus in the primary position had resolved in three patients, and four had complete to near-complete resolution of nystagmus in all gaze positions over subsequent months. Oscillopsia decreased concurrently. affording significant functional visual improvement. One patient had only slight functional improvement and continued to have prominent nystagmus seven years after operation. Smooth pursuit, optokinetic nystagmus and fixation suppression of vestibular nystagmus improved in all patients, but none had complete recovery at the higher velocities of stimulation. They still complained of visual blurring associated with head motion, probably due to the poor fixation suppression of vestibular nystagmus. Our findings suggest that abnormalities of eye movement in Arnold-Chiari malformation are due to compression of the herniating cerebellum against the caudal brain-stem and not a congenital aberrancy of oculomotor pathways. Nystagmus resolved more readily than pursuit or fixation suppression abnormalities, but most patients showed gradual improvement in all abnormalities four months after operation.