论文部分内容阅读
目的 探讨感染相关性视神经周围炎的临床及影像学特征.设计回顾性病例系列.研究对象2011年4月至2014年1月北京同仁医院神经内科和北京友谊医院眼科诊治的视神经周围炎病例10例.方法 回顾分析患者的临床、影像及实验室资料,并进行随访.用SPSS软件进行数据统计.主要指标临床表现、实验室检查、影像学特征及预后.结果 10例患者中女性7例.平均发病年龄(33.8±12.7)岁(14～51岁).10例患者16眼受累,视力在0.1以下10眼(62.5％);至少l眼视力低于0.1者8例(80％).16只受累眼中有轻到中度视盘水肿者13眼(81.3％),其中2眼伴视盘周围火焰状出血.全部患者完成至少1次头颅MRI检查,其中7例进行了增强扫描并均发现有视神经鞘强化.所有患者均接受了糖皮质激素治疗,其中2例同时接受了抗病毒药物治疗.平均随访(854.1±198.1)天(400～1035天).除4眼最终随访视力0.5以下,其余均恢复至1.0或以上.结论 感染相关性视神经周围炎与原发脱髓鞘性视神经炎临床表现类似,但双眼受累更多见,视盘水肿及盘周出血更明显,可能与前驱感染相关.影像学表现为视神经信号增高及增粗,增强后可见视神经鞘强化,需与视神经鞘膜瘤鉴别.经糖皮质激素治疗后视功能大多数恢复较好.“,”Objective To study the clinical and radiographic features of infection-associated optic perineuritis(OPN).Design Retrospective case series.Participants 10 patients who diagnosed as OPN from April 2011 to January 2014 at Department of Neurology in Beijing Tongren Hospital and Department of Ophthalmology in Beijing Friendship Hospital.Methods Clinical,radiographic features and laboratory findings of all patients were reviewed,and followed up respectively.The data were analyzed with SPSS software.Main Outcome Measures Clinical manifestations,radiographic features,laboratory findings and the prognosis.Results Of 10 patients,7 were female.The ages of patients at disease onset varied from 14 to 51,averaged 33.8±12.7 years.The best corrected vision acuity (BCVA) at nadir was 0.1 or worse on 10 of 16(62.5％) affected eyes.Mild to moderate disc edema with 13 affected eyes(81.3％),and 2 with hemorrhage at the edge of optic disc.All patients have at least one brain MRI,and 7 demonstrated circumferential enhancement around the optic nerve.All patients received corticosteroid therapy.Follow-up time ranged 400 to 1035 days,averaged 854.1±198.1 days.BCVA at last were better than 1.0 except 4 eyes.Conclusion In contrast to demyelinating optic neuritis,infection-associated optic perineuritis are likely associated with preceding infection,more bilateral affected,more severe disc edema and hemorrhage at the edge of optic disc.MRI demonstrated circumferential enhancement around the optic nerve,easily be misdiagnosed as optic nerve sheath meningioma.Response to corticosteroid was dramatic.