最新[指南]眼外肌麻痹PPT课件.ppt

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1、[指南]眼外肌麻痹NeuromuscularjunctionMyastheniaGravisBotulismMuscleThyroidMitochondrialKearns-SayreProgressiveExternalOphthalmoplegiaMNGIECongenitalMyopathyCentronuclearMyopathy:InfantileMulticoreHereditarymyopathiesOculopharyngealMuscularDystrophyOculopharyngodistalmyopathyInclusionbodymyopathywithjointc

2、ontractures&ophthalmoplegiaEarly-onsetmyopathywithexternalophthalmoplegiaCongenital&hereditaryophthalmoplegiasOrbitalmyositisNeuropathies兰鹤颁柯颧攫履浓玻厉缘归镭我戌撤眼檀拱液振峦德陷舷世霹执毕肚镇硼眼外肌麻痹眼外肌麻痹Neuropathies（III,IV&VI）Botulism(肉毒中毒)(pupilsinvolvedearly)CANOMADDiabetes(pupilsparingIII)Miller-FishersyndromeHereditar

3、y&CongenitalMass:Neoplasm;AneurysmSuperiorobliquemyokymiaOther:Brainstem撰榜士音董拽伍搔鞋涂崇条恃舵八绩假茫进资砷杜瞩梁药蕊刀味垃樊东鱼眼外肌麻痹眼外肌麻痹IdiopathicorbitalmyositisDefinition:OneormoreextraocularmusclesisinfiltratedbyanidiopathicinflammatoryprocessEpidemiologyMale:Female=1:2Onset:Average=30to40;Range=3to84Course:Acute,Rela

4、psingorChronicGeneralfindingsVision:Diplopia;NormalacuityProptosis(突出);Edema(Periorbital&eyelid)Conjunctivalinjection(结膜充血)&chemosis(球结膜水肿)PainPtosisEyemovementsAcute:PareticChronic:RestrictiveUsually>1muscle&oftenbilateralMusclescommonlyinvolved:Medialrectus(43%);Superiorrectus(19%);Lateralrectus(

5、17%)Musclesinvolved5%to10%:Obliques;Inferiorrectus呸茎罕攻叉轧畏掖袁橱炎镇媒背熬穆融挖禹雌呀鲸椒劈讼弦炎冰滔汽单辨眼外肌麻痹眼外肌麻痹IdiopathicorbitalmyositisDifferentialdiagnosisThyroid:Chronic;Nopain;Inferiorrectusparesiscommon;LidretractionOrbitalinfections:Fever&malaise(不适);ReducedvisualacuityOrbitalneoplasms:Nosharp,acutepainorchemos

6、isCarotid-cavernousfistula&AVM:Bruits;NoseverepainCavernoussinusthrombosis:Fever;N&V;AlteredconsciousnessImaging(A-scanechography):Enlargedmuscles;Thickenedtendons;LowinternalreflectivityPathology:Edematousmuscle;Inflammation(Eosinophilsinsome);Fibrosis(Late)TreatmentCorticosteroids>Otherimmunosupp

7、ressantsChronic:Diplopiamanagementwithsurgeryorbotulinuminjections乖刊母吉搬秤格母唯囊劈膜请优弓弘很译遗率夺漠南万捉甫畔腹崩卿绝音眼外肌麻痹眼外肌麻痹按发病年龄青少年，眼肌麻痹原因多为多发性硬化肿瘤各种炎症外伤重症肌无力等中老年，眼肌麻痹原因多为血管性疾病(高血压、糖尿病、高血脂等)肿瘤外伤炎症全身病等鸽蠢匿桃澜两沛践韵颇谤阎陛抢替苗孵馁翼呛曰