神經源性複視病例報告

Neurologic Diplopia: A Case Report

35歲女高職老師，2010年診斷第二型糖尿病，無規則藥物控制，亦無規則血糖監測。2016年4月28日晚飯後突然眼睛往左側觀看單一物體時變成兩個水平影像，症狀持續，隔天甚至出現雙手掌雙腳掌麻木，接著兩周內出現漸進性雙腳無力，甚至往右觀看一物體時也出現水平影像。患者分別於2016年4月29日至中興醫院及2016年5月13日至榮總醫院住院檢查，出院診斷為多發性神經病變合併雙側外旋神經麻r／o AIDP or DMpolyneuropathy。使用口服降血糖藥物及血漿置換。治療後下肢力量逐漸恢復且往右複視消失，往左看複視、手腳掌麻仍未減。患者於2016年5月25日至中醫門診求診，診斷為肝風夾外風之風牽偏視及氣虛血滯夾風之痹症，以針灸疏風通絡及中藥補氣活血，清胃熱，配合口服血糖藥、飲食、運動、體重控制。患者約一個月內持續兩個療程共12次中醫治療，眼睛往左複視症狀已無，雙手腳掌已不麻木，血糖得到良好控制。 A 35-year-old female teacher is a case of type 2 DM for 6 years without medical control. April 28th, 2016, she suddenly saw an image becoming two horizontal ones when eyes turning to left and felt dizziness. Next day, the symptom got worse and she even felt numbness on her hands and feet palms. After examination, the diagnosis was left CN6 palsy, related to DM s/p oral antidiabetic drug. But she didn’t get better and gradually felt lower limbs weak. Then she went to a medical center on May 13th, 2016. the discharge diagnosis was Acute inflammatory demyelinating polyneuropathy (AIDP) s/p plasma exchange. After treatment, even some symptoms improved, she still suffered from diplopia when eyes turning left and peripheral numbness in 4 limbs. So she went to Taipei Tzu Chi hospital to search for Chinese medical help on May 25th, 2016. After Chinese medical four examinations, the main diagnosis was interior liver wind and exterior wind caused diplopia. The second diagnosis was Qi deficiency and blood stasis caused numbness in 4 limbs. We use acupuncture to expel the wind and also use Chinese medicine to supply Qi, invigorate the blood and rectify her underlying body constitution at the same time. After Chinese treatment in 1 month, symptoms improved a lot. Reviewing the case, we thought the acute neurologically symptoms were closely related to “wind”, and Chinese treatment is effective for this case.

A 35-year-old female teacher is a case of type 2 DM for 6 years without medical control. April 28th, 2016, she suddenly saw an image becoming two horizontal ones when eyes turning to left and felt dizziness. Next day, the symptom got worse and she even felt numbness on her hands and feet palms. After examination, the diagnosis was left CN6 palsy, related to DM s/p oral antidiabetic drug. But she didn’t get better and gradually felt lower limbs weak. Then she went to a medical center on May 13th, 2016. the discharge diagnosis was Acute inflammatory demyelinating polyneuropathy (AIDP) s/p plasma exchange. After treatment, even some symptoms improved, she still suffered from diplopia when eyes turning left and peripheral numbness in 4 limbs. So she went to Taipei Tzu Chi hospital to search for Chinese medical help on May 25th, 2016. After Chinese medical four examinations, the main diagnosis was interior liver wind and exterior wind caused diplopia. The second diagnosis was Qi deficiency and blood stasis caused numbness in 4 limbs. We use acupuncture to expel the wind and also use Chinese medicine to supply Qi, invigorate the blood and rectify her underlying body constitution at the same time. After Chinese treatment in 1 month, symptoms improved a lot. Reviewing the case, we thought the acute neurologically symptoms were closely related to “wind”, and Chinese treatment is effective for this case.