Pontine lesion of the abducens fasciculus producing so-called posterior internuclear ophthalmoplegia.
Pontine lesion of the abducens fasciculus producing so-called posterior internuclear ophthalmoplegia.
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外展神经束的桥脑病变产生所谓的后核间性眼肌麻痹。
DOI：
10.1159/000117410
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发表时间：
1997
影响因子：
2.4
通讯作者：
Aldo Quattrone
中科院分区：
文献类型：
--
作者：
Luciano Oliveri;Francesco Bono;Aldo Quattrone
所谓的后核间眼麻痹（s-pINO）是一种罕见的水平凝视疾病，其特征是外展性瘫伴伴对侧眼内收眼球震。s-pINO的神经解剖学基础仍然不明确，因为尚未获得影像学资料[10]。我们描述了一个患有明确多发性硬化症（MS）的患者，其眼科特征强烈提示s-pINO。一位24岁男性，因右侧视突然出现复视，确诊为多发性硬化症。经神经学检查，他有右眼外展性瘫和对侧内收眼球震颤。在初级阶段，他的眼睛是正斜的。未见缩小或收敛异常。用固定的（20度）扫视序列研究垂直和水平眼运动。我们分析了Baloh等人所描述的延迟、准确性和峰值速度性能指数（PI）。水平跳眼运动的眼图（EOG）记录显示右眼外展缓慢（PI= 0.75，正常为1.10+/-0.15），左眼内收过度（128%，正常为97+/-15），而左眼PI在正常范围内。定性和定量分析垂直扫视和平滑追踪眼动正常。脑干诱发电位也在正常范围内。MRI检查采用0.5特斯拉单元（Vectra， GE医疗系统）和标准头线圈。采用常规非对比MR成像，采用周边门控自旋回波轴向和矢状位pd和T^ sub 2^加权扫描（TR= 3,076-3,428； TE= 20-100， FOV= 24 cm，矩阵192 × 256， NEX= 1，切片厚度= 5 mm，切片间隙= 1 mm）。附加矢状快速se切面，pd -和T^ sub - 2^加权（TR= 2,500； TE= 225-100， FOV= 24 cm，基质192 x 256， NEX= 3，切片厚度= 4mm，切片间隙= 1mm）聚焦于脑干。除了在T^ sub 2^和dp加权序列中典型的MS中分散的白质高信号外，我们在第四脑室前的右下脑桥发现了一个单一的高信号，影响外展神经束，部分累及旁脉脑桥网状结构（PPRF）。1）.
So-called posterior internuclear ophthalmoplegia (s-pINO) is an uncommon disorder of the horizontal gaze which is characterized by abduction paresis with associated adduction nystagmus of the contralateral eye. The neuroanatomical basis of s-pINO remains poorly defined as imaging data have not been available yet [1]. We describe a patient suffering from definite multiple sclerosis (MS) who presented with ophthalmologic features strongly suggestive of s-pINO.A 24-year-old male suffering from definite MS was admitted to our department because of sudden development of diplopia in right lateral gaze. On neurological examination, he had abduction paresis of the right eye and contralateral adduction nystagmus. In primary position his eyes were orthophoric. No miosis or convergence abnormalities were observed. Vertical and horizontal eye movements were studied with fixed (20 (degree)) saccade sequences. We analyzed latency, accuracy and peak velocity performance index (PI) as described by Baloh et al.[2]. Oculographic (EOG) recordings of horizontal saccadic eye movements showed slow abduction in the right eye (PI= 0.75; normal 1.10+/-0.15) with adduction overshoot in the left eye (128%; normal 97+/-15) whereas left eye PI was in the normal range. Qualitative and quantitative analysis of vertical saccades and smooth pursuit eye movements were normal. Brainstem evoked potentials were also within the normal range. MRI examination was performed with a 0.5-tesla unit (Vectra, GE medical system) with a standard head coil. Conventional noncontrast MR imaging was used, with peripheral-gated spin-echo axial and sagittal PD-and T^ sub 2^-weighted scanning (TR= 3,076-3,428; TE= 20-100, FOV= 24 cm, matrix 192 x 256, NEX= 1, slice thickness= 5 mm, slice gap= 1 mm). Additional sagittal fast-SE cuts, PD-and T^ sub 2^-weighted (TR= 2,500; TE= 225-100, FOV= 24 cm, matrix 192 x 256, NEX= 3, slice thickness= 4 mm; slice gap= 1 mm) were focused on the brainstem. Apart from scattered white matter hyperintensities typical of MS in T^ sub 2^-and DPweighted sequences, we identified a single hyperintensity in the right lower pons, anterior to the IVth ventricle, affecting abducens fasciculus and partially involving the paramedian pontine reticular formation (PPRF)(fig. 1).