以单侧上睑下垂为首发症状的脑桥梗死1例
A Case of Pontine Infarction with Unilateral Palpebrae Ptosis as the Initial Symptom

背景：单侧上睑下垂常见于中脑病变及面神经病变，常累及动眼肌核。全面的病史和体格检查是诊断和治疗上睑下垂的必要条件。单侧上睑下垂通常被认为是由神经肌肉连接或动眼神经病变引起的。在此，我们报告一个由脑桥梗死引起的单侧上睑下垂的病例。病例报告：患者，71岁男性，否认高血压、糖尿病、冠心病、房颤、中风、乙型肝炎、梅毒等病史。右侧上睑下垂是该病人的最初症状。约12小时后，患者出现右侧中枢性面舌瘫和右侧肢体瘫痪。面神经传导速度未见异常，初步排除面神经病变引起。结合患者头部MRI提示左侧脑桥急性梗死，查阅相关文献后，考虑与患者右侧上睑下垂相关。结论：其原因可能是梗死累及支配提上睑肌的神经纤维束，但目前的头颅MRI无法检测到。因此我们得出结论，单侧孤立性眼外肌麻痹可能提示后循环脑梗死。
Background: Unilateral palpebrae ptosis is common in midbrain lesions involving in the oculomotor nucleus. A thorough history and physical examination are essential for the diagnosis and treatment of palpebrae ptosis. Unilateral palpebrae ptosis is usually thought to be caused by neuromuscular junction or oculomotor neuropathy. Here, we reported a case of unilateral palpebrae ptosis result-ing from pontine infarction. Case Report: A 71-year-old man denied a history of hypertension, dia-betes, coronary heart disease, atrial fibrillation, stroke, hepatitis B, syphilis and other diseases. Right palpebrae ptosis was the initial symptoms of the patient. About 12 hours later, the patient developed right central facial paralysis and right limb paralysis. MRI of the head suggested infarc-tion in the left portion of pontine. Conclusions: The reason may be that the infarct involved the nerve fibers that innervate the levator palpebrae superioris, but the current cranial MRI can’t de-tect it. Therefore, unilateral isolated extraocular muscle paralysis may indicate cerebral infarction of posterior circulation.