视盘玻璃疣的影像

视盘玻璃疣的影像（英）ＫｈｅｔｅｒｐａｌＳ…／Ｅｙｅ．，１９９５，９（１）．６７～６９从视乳头水肿或者缺血性视神经病变引起的视盘水肿中，区分出掩蔽的视盘玻璃疣常常是困难的。作者对４例视盘肿胀的患者作眼底荧光血管造影、Ｂ型超声波、ＣＴ和ＭＲＩ检查。目的...     

40例视神经炎的磁共振成像分析

目的 探讨ＭＲＩ对视神经炎的临床诊断价值。方法 用ＭＲＩ的频谱预饱和反转恢复序 液体衰变反转恢复序列检查４０例（７５只眼）诊断为视神经炎的患者。结果 ４０例（７５只眼）视神经炎的病灶多见于视的眶内段（８６．７％）和管内段（２９．３％）,且以视神经的中轴（４９．３％）和全断面（３８．７％）为主。病灶长２～３５ｍｍ,平均１２．６ｍｍ。患者的视力与病变部位有关,且与病灶大小呈对数曲线负相关。视力差者（Ｐ     

缺血性视神经病变的诊断

缺血性视神经病变,我国70年代才有少数报导。由于对此病认识不足,常将其误诊为“急性视乳头炎”、“急性球后视神经炎”、视乳头水肿(双眼先后发病间隔期短)、Foster—kennidy综合症即额叶肿瘤(双眼先后发病间隔久,即先病眼已视神经萎缩而后得病之眼为视乳头水肿)。至于晚期,则认为是原因不明的视神经萎缩。我科自1973年3月至1984年3月共治疗75例110眼不同时期的缺血性视神经病变。男50例;女25例。双眼35例;单眼40例。     

福建地区莱姆病的眼底表现

本文报告福建地区莱姆病的眼底改变１５例，其中以中浆病样表现最多见有１１例，视神经乳头炎２例，视神经视网膜炎１例，视乳头水肿继发性视神经萎缩１例。在流行区对于原因不明的眼病包括眼底病，应常规检测血清莱姆病抗体。同时，我们认为不同地区的莱姆病临床眼部表现可能不同，值得进一步研究。     

首诊为视神经炎的急性视力下降81例病因分析

目的：了解初诊为视神经炎的急性视力下降患者的病因。方法：收集临床初诊为视神经炎的急性视力下降患者81例，进行详细的临床检查以及相应的实验室、电生理学和影像学检查，综合分析病例重新诊断。结果：81例初诊为视神经炎的急性视力下降患者中，49例(60.5％)符合视神经炎临床诊断；其中23例符合炎性脱髓鞘性视神经炎的临床和实验室特点。9例患者的视神经炎以鼻窦炎为可能病因；少数病例为结核性、病毒性或梅毒性视神经炎；13例视神经炎患者病因不明，其中5例临床疑诊为Leber遗传性视神经病变(LHON)者3例进行线粒体DNA(mt-DNA)11778位点突变检查，2例阳性。81例患者中有32例不符合视神经炎的诊断，其中以缺血性视神经病变、心因性视力下降和颅内肿瘤等疾病造成的视神经压迫和／或视乳头水肿较常见。结论：缺血性视神经病变等很多疾病易与视神经炎混淆，正确诊断视神经炎需要严格和详细的临床和实验室检查；对于病因不明的视神经炎患者，进行与LHON相关的mt-DNA突变的筛查，可能有助于其诊断和鉴别诊断。     

假性视乳头炎三例

假性视乳头炎三例曹燕例１患者女，４５岁。１９８９年体检时行眼部检查，双眼远、近视力均为１．５。外眼无异常。眼底检查：视盘水肿、边界不清，隆起约２～３Ｄ、生理凹陷看不清，黄斑无渗出、中心窝光反射清晰，血管自视盘分出、走行正常，视网膜血管正常，ＡＶ＝２３...     

视神经炎临床误诊54例分析

目的：对54例其他疾病误诊为视神经炎的临床资料进行分析,探讨减少误诊的措施。
　　方法：对2000－09／2013－06被误诊为视神经炎的54例患者的临床资料进行分析,总结其误诊特点。
　　结果：不少疾病极易被误诊为视神经炎,易误诊疾病包括缺血性视神经病变、颅内肿瘤、视乳头血管炎、有髓神经纤维等。
　　结论：详细询问病史,完善辅助检查,加强眼底疾病及神经眼科知识的学习,有助于减少眼底表现近似视神经炎的疾病的误诊。     

垂体瘤误诊2例

垂体瘤误诊２例中国医科大学附属第一医院眼科贾友志，洪晶例１张××女４８岁双眼视力下降一年。曾诊为球后视神经炎，经治疗未见好转来我院就诊。右眼视力０．４，左眼视力０．３，均不能矫正。外眼无改变。屈光间质清晰。眼底检查视乳头色淡，界清，动脉细，反光强。视...     

首诊于眼科的颅内静脉窦血栓形成误诊分析

目的探讨眼科临床工作中颅内静脉窦血栓形成(cranialvenoussinusthrombosis,CVST)误诊的常见原因。方法回顾性分析21例CVST患者的临床资料与误诊情况。结果本组以头痛为首发症状者4例,视物模糊6例,头痛伴视物模糊4例,一过性黑朦2例,视力下降3例,视物变形1例,眼前黑影飘动1例。本组21例眼底检查均表现为视盘水肿。其中首诊时8例误诊为视神经乳头炎,3例误诊为视盘血管炎,2例误诊为视神经网膜炎,2例误诊为屈光不正、弱视,1例误诊为缺血性视神经病变,1例误诊为视盘玻璃膜疣。4例没有明确诊断,只诊为视盘水肿。结论采集病史和体检不够全面以及对CVST的临床特征缺乏深入的认识是眼科临床工作中CVST误诊的主要原因。     

眶尖部肿瘤的诊断与治疗

本文回顾性分析了我院诊治的眶尖部肿瘤２９例。病理检查为海绵状血管瘤１０例，神经鞘瘤８例（其中复发性神经鞘瘤３例），视神经鞘脑膜瘤７例，继发肿瘤及转移瘤３例。眶尖肿瘤主要表现早期视力障碍，轻度眼球突出，眼底视盘水肿或萎缩，早期易误诊。ＣＴ及ＭＲＩ显示眶尖部肿瘤，手术难度较大，合并症多。本文讨论了几种常见眶尖肿瘤的临床诊断特点、手术治疗原则及注意事项     

后天性外展神经麻痹的MRI病因学分析

 目的 探讨后天性外展神经麻痹的MRI表现,分析外展神经麻痹原因,为临床诊断、治疗提供依据。设计 回顾性病例系列。研究对象 42例后天性外展神经麻痹患者。方法 回顾性分析42例临床诊断证实的后天性外展神经麻痹患者的MRI表现,包括病变部位、范围、信号和强化特征,结合外展神经的解剖特点,分析神经麻痹的原因。主要指标 MRI表现。结果 缺血性外展神经麻痹16例,患者均有糖尿病、高血压或高脂血症等病史,MRI表现为颅内多发缺血灶、软化灶,老年性脑萎缩等。占位性病变15例,病变位于桥前池、岩尖和海绵窦,累及展神经脑池段、Dorello小管段和海绵窦段。外伤性外展神经麻痹5例,1例有右侧颅骨多发骨折,出现左侧外展神经麻痹症状,其余4例均无明确颅骨和眼眶骨折证据。非特异性炎症4例,3例表现为海绵窦偏前部增厚、强化。其他原因包括重症肌无力1例,桥小脑角区胆脂瘤术后1例。结论 MRI检查有助于明确外展神经麻痹的病因及发病部位,进而指导针对性治疗。（眼科,2013, 22： 305-308）     

Enhancement and demyelination of the intraorbital optic nerve. Fat suppression magnetic resonance imaging.

Conventional spin-echo magnetic resonance imaging (MRI) of intraorbital optic neuritis is hampered by the adjacent high signal and chemical shift artifact of orbital fat. Frequency-selective saturation pulse MRI reduces these problems and was used to determine its utility in evaluation of intraorbital optic neuritis. Eight consecutive patients with optic neuritis underwent MRI within 1 week of the onset of visual loss. Conventional MRI with T1, proton density, and T2 weighting and frequency-selective saturation pulse MRI with T1, proton density, and T2 weighting were performed. After administration of intravenous gadopentetate dimeglumine, T1-weighted conventional and frequency-selective saturation pulse MRI were performed. Frequency-selective saturation pulse MRI showed gadopentetate dimeglumine enhancement in the intraorbital optic nerve in 7 patients and the intracranial optic nerve in 3 patients. Conventional MRI failed to show optic nerve gadopentetate dimeglumine enhancement in patients with intraorbital lesions, but did show intracranial lesions. Frequency-selective saturation pulse MRI showed bilateral optic nerve enhancement in 3 patients with unilateral visual signs and symptoms. Proton density and T2-weighted conventional MRI of the brain showed no convincing signal aberrations in the optic nerves. In the MRI evaluation of intraorbital optic neuritis: (1) frequency-selective saturation pulse fat suppression MRI is superior to T1-weighted conventional MRI in the detection of gadopentetate dimeglumine enhancement; (2) frequency-selective saturation pulse proton density and T2-weighted MRI is superior to proton density and T2-weighted conventional MRI; (3) frequency-selective saturation pulse MRI showed gadopentetate dimeglumine enhancement as well as proton density/T2-weighted signal aberration in exactly the same portion of the intraorbital optic nerve.     

眶尖部及视神经肿瘤的早期诊断

目的探讨眶尖部及视神经肿瘤在眼球突出前的临床表现、影像学检查特征及临床诊断要点。方法回顾性分析22例无明显眼球突出单侧眼眶肿瘤患者的病历资料,包括主要症状、首发表现、临床诊治过程及影像学检查结果。结果22例肿瘤患者中,海绵状血管瘤6例,神经鞘瘤、视神经鞘脑膜瘤、鼻窦及鼻咽腔恶性肿瘤眶内蔓延各4例,后组筛窦黏液囊肿2例,神经纤维瘤和视神经胶质瘤各1例。以视力下降为首发症状者17例,视力下降合并复视者3例。全部患者均在CT或MRI检查后确诊。肿瘤位于眶尖部或起源于视神经。结论眶尖部及视神经肿瘤的早期症状是视功能障碍,无眼球突出表现。视力呈缓慢进行性下降,按视神经炎治疗效果差。CT或MRI检查对早期诊断起重要作用。     

Use of magnetic resonance imaging to differentiate optic neuritis and nonarteritic anterior ischemic optic neuropathy

OBJECTIVE: To determine if magnetic resonance imaging (MRI) of the optic nerves obtained during the acute phase can distinguish patients with optic neuritis (ON) from those with nonarteritic anterior ischemic optic neuropathy (NAION). DESIGN: Retrospective, neuroradiologic, observational study. PARTICIPANTS: Sixty-four patients diagnosed as having either ON or NAION who were diagnosed by clinical criteria and imaged by MRI. METHODS: Demographic information on the MRI scans was masked and the patients were presented randomly and in a blinded fashion to a neuroradiologist (JDR) for determination of abnormalities. Reproducibility was assessed by presenting 10 of the scans a second time to the same neuroradiologist. MAIN OUTCOME MEASURES: The presence or absence and location of abnormal MRI signals of the optic nerve. RESULTS: Evaluation of reproducibility revealed identical interpretations of the ten scans submitted a second time. The optic nerve was abnormal in the clinically affected eye in 31 of the 32 ON patients but in only 5 of the 32 NAION patients. Thirty of the 31 ON patients who received gadolinium had enhancement, and 27 of the 32 ON patients had increased short T(1) inversion recovery signal in the clinically affected optic nerve. The five NAION patients with abnormal scans in the clinically affected eye had increased short T(1) inversion recovery signal, and in two of these, there also was enhancement of the optic nerve. For the ON patients, enhancement involved the entire length of the intraorbital optic nerve in 18 cases and the intracranial segment of the optic nerve in 19 cases. CONCLUSIONS: Our study shows that MRI scanning of the optic nerve shows significantly different results between patients clinically diagnosed with either ON or NAION.     

The pattern of optic nerve fiber loss in anterior ischemic optic neuropathy

Postmortem quantification of the remaining optic nerve fibers in three eyes with nonarteritic anterior ischemic optic neuropathy showed that the loss of fibers was complete in the superior half of each nerve and included loss of peripheral fibers in the other half. The fibers with the greatest resistance to atrophy were found in the middle of the nerve cross section. The pattern was similar to that found in a previous example of anterior ischemic optic neuropathy and unlike that found in glaucoma or other optic neuropathies studied in similar fashion.     

Evaluation of the Optic Nerve Complex in the Orbit Using Coronal Fast Magnetic Resonance Imaging

Recently available coronal fast magnetic resonance imaging (MRI) has very high spatial resolution with good contrast between the optic nerves and cerebrospinal fluid (CSF). The aim of this study was to evaluate the diagnostic value of coronal fast imaging in optic nerve diseases. Thirty-five patients with various Neuro-ophthalmic conditions including 9 with optic neuritis, 6 with optic atrophy, 5 with glaucoma, 4 with segmental optic nerve hypoplasia and 11 with other optic neuropathies including orbital apex syndrome were evaluated with the three-dimensional fast imaging employing steady-state acquisition (FIESTA) sequence in addition to standard MRI protocols. The optic nerve complexes were evaluated on coronal images of the orbits. Detailed demonstration of the optic nerve complex—the optic nerve, the perineural CSF space and dural sheath—could be readily obtained with FIESTA sequence. The acute phase of both optic neuritis and perineuritis showed enlargement of the perineural CSF space; the optic nerve was swollen in optic neuritis but not in perineuritis. Cases of optic atrophy and glaucoma showed perineural CSF space enlargement with normal optic sheath circumference and a thinner optic nerve, while optic nerve hypoplasia showed a smaller dural sheath circumference without perineural CSF space enlargement. In the cases of orbital apex syndrome optic nerve compression by the extraocular muscles was clearly shown. Coronal FIESTA imaging of the orbit is capable of delineating detailed structural changes in the optic nerve complex and is of diagnostic value for the differentiation of optic nerve diseases.     

123例单纯性动眼神经麻痹的MRI病因学分析

目的 探讨单纯性动眼神经麻痹的MRI表现及病因。设计 回顾性病例系列。研究对象123例单纯性动眼神经麻痹患者。方法 回顾性分析患者的MRI表现,结合动眼神经的解剖特点,分析动眼神经麻痹的病因。主要指标  MRI表现。结果 123例动眼神经麻痹病例中,MRI表现异常者87例（70.7%）。其中海绵窦区病变62例（71.2%）（炎症45例,颈内动脉动脉瘤8例,鼻咽部/蝶窦/鞍区/鞍旁占位性病变累及海绵窦者6例,颈内动脉海绵窦瘘2例,颈内动脉海绵窦段增粗迂曲1例）;脑干病变16例（18.4%）（中脑梗塞15例,中脑炎症1例）;颅眶沟通性病变5例（5.7%）（炎症3例,肿瘤2例）;动眼神经脑池段及其周围病变4例（4.6%）（动眼神经炎性病变2例,动眼神经神经鞘瘤1例,脚间池胆脂瘤压迫动眼神经1例）。结论 单纯性动眼神经麻痹的病因多样,海绵窦区病变占大多数。MRI检查有助于明确动眼神经麻痹的病因。（眼科, 2015, 24： 304-308）     

Optic nerve lesion following neuroborreliosis: a case report.

PURPOSE: Neuroborreliosis may cause various neuro-ophthalmological complications. We describe a case with a bilateral optic neuropathy. CASE REPORT: A 58-year-old female developed facial paresis six weeks after an insect bite. One week later she developed bilateral optic disc swelling with haemorrhages and nerve fibre bundle defects in the lower visual field of the left eye. In CSF and serum, raised IgM and IgG titres to Borrelia burgdorferi were found. Systemic antibiotic treatment led to improvement of the vision and facial paresis, but not all visual field defects resolved, probably due to ischemic lesions of the optic disc. DISCUSSION/CONCLUSIONS: In optic nerve lesions due to neuroborreliosis it is difficult to distinguish between inflammatory and ischemic lesions. This patient demonstrated features of an ischemic optic nerve lesion.     

Optic neuropathy in uremia

We examined three patients who developed optic neuropathies while undergoing chronic hemodialysis. One patient developed severe bilateral deterioration of vision, but recovered totally four weeks after discontinuing deferoxamine chelation therapy. Another patient had bilateral visual loss associated with chronic papilledema of idiopathic increased intracranial pressure. A third showed atypically severe consecutive anterior ischemic optic neuropathy. The latter two patients showed little improvement with high-dose intravenous methylprednisolone therapy combined with more vigorous hemodialysis. These cases, in addition to those previously described, underscore the heterogeneity of optic nerve disease in patients with uremia.     

眼附属器淋巴瘤的影像学表现及其临床意义

目的 了解眼附属器淋巴瘤的CT和MRI表现.方法 回顾性分析经手术或活检病理证实的50例眼附属器淋巴瘤的影像学表现,其中31例行CT扫描,8例MRI扫描,11例行CT和MRI扫描.结果 侵犯眼睑或结膜18例,泪腺6例,肌锥内外11例,肌锥外8例,肌锥内2例,眼外肌受累16例,视神经受累13例.7例肿瘤呈铸造样包裹整个眼球.结论 眼附属器淋巴瘤的影像学表现有一定特征性,MRIH脂肪抑制技术有助于了解肿瘤范围.