一次性外傷性動眼神経麻痺：自験10例の検討

Primary Oculomotor Nerve Palsy due to Head Injury:Analysis of 10 cases

I．はじめに

　頭部外傷に起因する動眼神経麻痺のうち，脳ヘルニアによる二次性障害を除いた一次性動眼神経麻痺は比較的まれで報告例も少なく，その臨床経過や予後についてあまり知られていない．今回，一次性動眼神経麻痺10症例について検討し，若干の知見を得たので報告する．

Ten cases of primary oculomotor nerve palsy due to head injury are presented. All ten patients had a di-lated, non reactive pupil. Seven had complete oculomo-tor palsy. Two had partial extraocular palsy or blephar-optosis and one had neither extraocular palsy nor blepharoptosis. The initial ophthalmoplegia was recog-nized immediately after trauma. Nine patients had se-verely impaired consciousness on admission, but eight patients recovered fully within two months after the traumatic event, while one patient remained disoriented.Emergency CT scan on admission showed mass lesions in no patients except one who had a hematoma measur-ing 3 cm in the frontal lobe, but had no herniation sign.Patients with complete oculomotor palsy had a high in-cidence of traumatic SAH (71%) or skull fracture (57%). Recovery from third nerve palsy was not so good. The follow-up period extended from 3 months to 18 months. Of the 10 patients, none recovered com-pletely from third nerve palsy. The prognoses of blepharoptosis, external ophthalmoplegia and internal ophthalmoplegia were analyzed separately. The recov-ery rates were 78%, 44% and 20%, respectively, the in-ternal ophthalmoplegia showing poorest recovery. We discuss the mechanism of direct injury to the oculomo-tor nerve.