A69-year-oldblackmanwithvascularriskfactors,includinghypertension,hyperlipidemia,andpoorlycontrolleddiabetesmellitus,whowastreatedwiththevascularendothelialgrowthfactorinhibitor,bevacizumab,formaculardegeneration,experiencedsuddenonsethorizontaldiplopiaassociatedwithfatigue.Hisdeficitsdidnotpreventhimfromdriving.Thenextmorninghenoticedrighteyeptosisobscuringhisvision.Becauseofworseningsymptoms,thepatientpresentedtotheemergencydepartmentwherehewasfoundtohavebilateralptosis,rightgreaterthanleft,andleftinternuclearophthalmoplegia(INO).Pupilswereequalandreactivetolight.Generalneurologicalexaminationrevealedperipheralneuropathywithdecreasedpinprick/lighttouchandvibration/jointpositionsensedistallyinthelowerextremitieswithassociateddifficultywithtandemwalkandpositiveRombergsign.InitialNationalInstitutesofHealthStrokeScalewas2forpartialgazepalsyandsensorydeficits.Hedidnotqualifyforthrombolysisbecauseofminordeficitsandsymptomslastinglongerthan4.5hours.
69岁黑人男子，患高血压、高血脂、控制不佳的糖尿病等多种血管危险因素，因黄斑变性应用血管内皮生长因子抑制剂贝伐珠单抗治疗，突发与疲劳相关的水平性复视。复视没有妨碍他开车。第二天患者右眼上睑下垂遮挡视力。因为症状加重，患者就诊于急诊科，查体患者双侧上睑下垂，右侧较左侧明显，左侧核间性眼肌麻痹（INO）。双侧瞳孔等大，对光反射灵敏。一般神经系统检查显示周围神经病变，患者双下肢远端针刺觉/轻触觉、震动觉/关节位置觉减退，直线行走困难，闭目难立征阳性。最初有部分性凝视麻痹和感觉障碍，HIHSS评分2分。因为患者症状轻微，持续时间超过4.5小时，不适合溶栓。
Thepatientwasadmittedtotheneurologyservicewithsuspectedstroke.MRIofthebrainrevealedamidbrainmidlinediffusionrestrictionwithapparentdiffusioncoefficientcorrelatejustventraltotheaqueductofSylviusslightlymoreextendedtotherightconsistentwithsubacuteischemicstrokeinvolvingthenucleusofoculomotornerveandadjacentmediallongitudinalfasciculus(MLF)likelysecondarytosmall-vesseldisease.MRangiographyoftheheadandneckdidnotshowsignificantintracranialorextracranialvasculardisease.Transthoracicechocardiogramrevealednormalheartfunctionandnopatentforamenovale.
患者因怀疑脑卒中被收入神经科住院。头磁共振显示中脑中线ADC弥散受限，位于中脑导水管腹侧稍偏右，符合亚急性缺血性脑卒中，累及动眼神经核及相邻的内侧纵束（MLF），很可能继发于小血管病。头、颈MRA没有发现明显的颅内或颅外血管病变。经胸超声心动图示心功正常，无卵圆孔未闭。
Thepatientwasstartedonaspirinandastatinandprovidedaneyepatchfor北京白癜风治疗要花多少北京手术治疗白癜风费用
