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NEJM：眼睑下垂-病例报道

2017-07-06 xing.T MedSci原创

眼睑下垂重症肌无力不对称
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在眼睑的上睑提肌有大致相等的神经支配。在不对称性上睑下垂的情况下，增加运动冲动，以弥补下垂受影响更多的一侧，从而使两个眼睑相平，这就足以掩盖受影响较小的轻度下垂一侧眼睑。手动提起受影响的眼睑，需要保持眼睑抬高得到缓解，这些运动冲动减弱，从而揭示了对侧眼睑下垂的机制。

患者为一位27岁的女性，因眼睑下垂，并且在下午进一步恶化的病史而到三级医疗中心就诊。该患者报告没有其他神经症状，如复视、无力、肢体麻木、易疲劳、语音和吞咽障碍等。该患者瞳孔双侧对称、圆的、对光分数和调节反射正常，左侧眼睑明显下垂（如图A所示），持续向上凝视眼睑下垂加重。右眼睑似乎不受影响；然而，手动提起左侧眼睑引起右侧上睑下垂。实验室检查显示乙酰胆碱受体抗体水平为4.56nmol/L（正常值＜0.05nmol/L），这一发现与重症肌无力诊断一致。在眼睑的上睑提肌有大致相等的神经支配。在不对称性上睑下垂的情况下，增加运动冲动，以弥补下垂受影响更多的一侧，从而使两个眼睑相平，这就足以掩盖受影响较小的轻度下垂一侧眼睑。手动提起受影响的眼睑，需要保持眼睑抬高得到缓解，这些运动冲动减弱，从而揭示了对侧眼睑下垂的机制。该患者患有重症肌无力，但这种现象可能发生在那些由于任何外部原因而导致眼睛不对称的上睑下垂的患者上。该患者服用吡啶斯的明和泼尼松治疗，使上睑下垂得到了迅速改善，并且在2年的随访中该患者一直保持良好。原始出处：Sunil Kumar,et al. Unmasking Ptosis in

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1684095, encodeId=7328168409584, content=<a href='/topic/show?id=bf59e2814cf' target=_blank style='color:#2F92EE;'>#眼睑#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72814, encryptionId=bf59e2814cf, topicName=眼睑)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9d8928034409, createdName=zhangbaojun, createdTime=Tue Mar 13 00:00:00 CST 2018, time=2018-03-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=219125, encodeId=7bd22191251f, content=谢谢分享，学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Thu Jul 06 10:07:45 CST 2017, time=2017-07-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=219099, encodeId=6d25219099a0, content=学习，谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhb9xDeHojCicsdRdyC3XXdGk2ib9yLypZuHN06WeW4HO8WN0GGrgEfvnTX8gsckof05GHOU5OM4Mvx/0, createdBy=9cee1982656, createdName=执着追梦, createdTime=Thu Jul 06 09:18:48 CST 2017, time=2017-07-06, status=1, ipAttribution=)]
    2018-03-13 zhangbaojun

    #眼睑#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1684095, encodeId=7328168409584, content=<a href='/topic/show?id=bf59e2814cf' target=_blank style='color:#2F92EE;'>#眼睑#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72814, encryptionId=bf59e2814cf, topicName=眼睑)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9d8928034409, createdName=zhangbaojun, createdTime=Tue Mar 13 00:00:00 CST 2018, time=2018-03-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=219125, encodeId=7bd22191251f, content=谢谢分享，学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Thu Jul 06 10:07:45 CST 2017, time=2017-07-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=219099, encodeId=6d25219099a0, content=学习，谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhb9xDeHojCicsdRdyC3XXdGk2ib9yLypZuHN06WeW4HO8WN0GGrgEfvnTX8gsckof05GHOU5OM4Mvx/0, createdBy=9cee1982656, createdName=执着追梦, createdTime=Thu Jul 06 09:18:48 CST 2017, time=2017-07-06, status=1, ipAttribution=)]
    2017-07-06 明月清辉

    谢谢分享，学习了

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1684095, encodeId=7328168409584, content=<a href='/topic/show?id=bf59e2814cf' target=_blank style='color:#2F92EE;'>#眼睑#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72814, encryptionId=bf59e2814cf, topicName=眼睑)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9d8928034409, createdName=zhangbaojun, createdTime=Tue Mar 13 00:00:00 CST 2018, time=2018-03-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=219125, encodeId=7bd22191251f, content=谢谢分享，学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Thu Jul 06 10:07:45 CST 2017, time=2017-07-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=219099, encodeId=6d25219099a0, content=学习，谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhb9xDeHojCicsdRdyC3XXdGk2ib9yLypZuHN06WeW4HO8WN0GGrgEfvnTX8gsckof05GHOU5OM4Mvx/0, createdBy=9cee1982656, createdName=执着追梦, createdTime=Thu Jul 06 09:18:48 CST 2017, time=2017-07-06, status=1, ipAttribution=)]
    2017-07-06 执着追梦

    学习，谢谢分享

    0