Eye muscle paralysis

Introduction The oculomotor (III), the trochle (IV) and the abduction (VI) are the motor nerves that dominate the eye muscles. The skull injury can affect the extraocular muscles and III, IV, and VI on the cranial nerve. Various forms of eye muscle spasm.

Cause

The cause of eye muscle spasm:

(A) aneurysm: an aneurysm of the cerebral artery ring often causes paralysis of the eye movement.

The internal carotid artery aneurysm in the cavernous sinus can cause paralysis of the eye, the trochlear, the abductor nerve, and the trigeminal nerve branch, called the cavernous sinus syndrome. Aneurysms of the posterior cerebral artery, the superior cerebellar artery, and the posterior communicating artery can cause oculomotor palsy. Oculomotor paralysis caused by aneurysms is almost always accompanied by pupil dilation and fixation, ipsilateral eye pain or headache. The drooping of the affected eyelid is also more common. An aneurysm can be diagnosed by DSA.

(B) head injury: can affect the extraocular muscles and III, IV, VI on the cranial nerve and cause various forms of eye tendon.

Extraocular muscle contusions, orbital fractures, and apical fractures can cause multiple extraocular tendons. Cervical cavernous sinus fistula can cause pulsatile eyeball protrusion and extraocular tendon. Fractures in the bed and the apex of the humerus are particularly prone to invasion of the abductor nerve. When the intracranial hematoma caused a cerebral palsy, ipsilateral oculomotor nerve paralysis and contralateral hemiplegia occurred. Intraocular tendons can sometimes be caused by an injury to the eyeball or ciliary ganglion.

(3) Infection:

1. Cavernous sinus syndrome is caused by cavernous sinus thrombosis or thrombotic cavernous sinusitis, often secondary to head and face carbuncle or sepsis, eyeball protrusion and fixation, pupil dilated, conjunctiva and congestive edema near the eyelid; There is papilledema, loss of vision or even complete blindness. If the cavernous sinus thrombus obstruction is re-communicated or the collateral circulation is established, the eyeball protrusion can be significantly alleviated. One side of the cavernous sinus thrombosis can also spread to the contralateral cavernous sinus within a few days through the sinus sinus and bilateral symptoms appear. Inflammation in the cavernous sinus can also spread to nearby tissues causing meningitis and brain abscess.

2. Supposition of supracondylar syndrome and supracondylar syndrome The supracondylar syndrome manifests as cranial nerve dysfunction of III, IV, VI, V1, but there is no local inflammatory manifestation; if it is accompanied by eyelid pain, it is called Tolosa-Hunt synthesis. Sign. Those with visual impairment are called apex syndrome. Can be caused by local chronic infection.

3. Other eye movements, trochlear and abductor nerve inflammation can also cause paralysis of these nerves. When otitis media or chronic mastoiditis develops to destroy the tip of the rock into the skull, it causes the V and VI on the affected side to be cranial nerve dysfunction, called the rock bone tip syndrome or the Gradenigo syndrome. Ocular muscle dyskinesia can occur in various skull base meningitis and encephalitis.

(4) Myasthenia gravis is a common cause of eye muscle spasm. Extraocular muscles are easily fatigued, and symptoms can be aggravated by continuous exercise and reduced after rest. The symptoms are the lightest in the morning and the symptoms worsen every afternoon or evening.

(5) Tumor brain stem tumors are a common cause of cranial nerve nucleus paralysis in III, IV, and VI. Sphenoid ridge meningioma, parasagittal meningioma, etc. can directly oppress the motor nerve of the eye. The abductor nerve is long in the intracranial stroke. When the intracranial hypertension is high, it is easily compressed or pulled to produce abductor nerve paralysis. Nasopharyngeal carcinoma can directly invade into the skull from the holes in the skull base and cause eye muscle spasm.

(6) Other cerebral arteriosclerotic vascular diseases can often cause eye muscle spasm due to vascular obstruction, compression or bleeding. Diabetes can be caused by diabetic ischemic lesions and ocular spasm. A small number of migraine patients have dilated pupils and extraocular tendons with varying degrees of ipsilateral in or after migraine attacks. Ocular muscle muscular dystrophy is a rare hereditary disease that can eventually occur in all extraocular muscles. Congenital eyelid drooping and pseudotumor in the eyelid can cause eye muscle spasm. Eye muscle spasm caused by Wernicke encephalopathy is caused by a lack of vitamin B1. Hyperthyroidism or loss of pituitary function can also produce eye muscle spasm and eyeball protrusion.

an examination

Related inspection

Ophthalmologic examination of slit lamp eye and sacral area CT examination eye function examination brain CT examination

Examination and diagnosis of eye muscle spasm:

When the nerve is damaged, eye movement disorder (eye muscle spasm) and pupil dilation function are abnormal. The damage of the eye movement nerve can be divided into three types: peripheral type, karyotype and nuclear type.

(1) Peripheral lesions: manifested as restricted eye movement, strabismus and diplopia. When the oculomotor nerve is completely paralyzed, there is a ptosis, an extraocular slant, an enlarged pupil, a reaction to light, and a disappearance of the regulatory response. The ocular external slant is caused by the loss of antagonism of the lateral rectus tendon and the lateral rectus muscle. The affected eye can't move up, down, or inward, but it can still move slightly outward, because the superior oblique muscle is still normal. Dilated pupils are caused by paralytic fiber paralysis. Due to the sputum of the ciliary muscle, the lens is dysregulated, resulting in blurred myopia.

(B) karyotype lesions: the characteristics of karyotypic tendon are:

1 oculomotor and trochlear nucleus paralysis are mostly bilateral, but often asymmetrical.

2 more lesions with adjacent tissues, such as the damage of the oculomotor nucleus mostly combined with the damage of the medial longitudinal bundle, the intraocular and external tendon and the dyskinesia of both eyes; when the abductor nucleus is damaged, Often combined with the affected side of the face, trigeminal nerve palsy, and the two eyes of the same movement disorder.

3 selectively damages only part of the function of the eye muscles, resulting in so-called isolated eye muscle spasms.

4 The bilateral pupils may disappear from the light reaction, and the regulation reaction still exists.

5 often combined with long bundles (cone beam, sensory bundle) damage signs.

(C) nucleus type lesions: when the supra-tonal eye muscle spasm, two eyes combined with dyskinesia, the eyes can not coordinate upwards, downwards or to one side, called gaze paralysis. The most common types are two eyes with the same level of gaze and two eyes with the same vertical movement of paralysis.

Examination: Mainly for eye examination, brain CT to exclude intracranial organic lesions.

Complications: When the eye, the trochlear and the abductor nerve are combined with complete paralysis, the complete eye muscle spasm is produced, the eyeball is fixed in the median position, the movement in all directions is not possible, the pupil is dilated, and the light and regulation response disappear. Paralysis of the two eyes in the same vertical vertical motion (Parinaud syndrome) is caused by lesions in the midbrain of the midbrain, often with pupil dilation and disappearance of photoreaction. A small number of patients are paralyzed in the same vertical movement.

Differential diagnosis

Symptoms of eye muscle spasm that are easily confused:

The so-called ophthalmoplegia is peripheral ophthalmoplegia: a single muscle or the same innervating muscle dyskinesia, autonomic movement and reflex movement are all obstacles, rarely accompanied by other neurological symptoms.

Nuclear vertical eye muscle spasm: seen in juvenile type (C type chronic neurotype) Niemann-Pick's disease, more common in children, a small number of children or juvenile onset, cherry erythema or supranuclear vertical eye muscles can be seen in the fundus.

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