高压氧治疗急性视神经炎的疗效观察

目的 :探讨高压氧治疗急性视神经炎的疗效及机理。方法 :回顾分析高压氧治疗急性视神经炎74例患者的临床资料。治疗方法皆为高压氧加用扩血管药物。结果 :视乳头炎有效率达 72 .3% ,球后视神经炎有效率达 77.5 % ,两组总有效率达 78.3%。结论 :高压氧是治疗急性视神经炎的有效方法 ,治疗时机宜早不宜迟     

Blurred vision and pain in the eye

Subacute unilateral visual impairment accompanied by pain on eye movement is characteristic of optic neuritis. Most cases of optic neuritis resolve spontaneously, and acute treatment with intravenous steroids hastens recovery but does not alter the ultimate visual outcome. Brain magnetic resonance imaging (MRI) may permit a diagnosis of multiple sclerosis (MS) to be made after a single clinical demyelinating event such as optic neuritis. Current evidence supports the introduction of disease-modifying therapy in patients with a single clinical event such as optic neuritis and brain MRI compatible with MS. The diagnosis of MS is a confronting life event associated with significant personal, social and financial burdens. The diagnosing neurologist should provide a detailed explanation of the disease and its clinical spectrum and introduce the patient to the wide range of support services, educational material and MS clinics.     

视神经炎的中医治疗进展

目的：探讨以中医为主,中西医结合治疗急性视神经炎的思路,提高本病的诊疗水平。方法：论述中医结合治疗视神经炎的方法,提出辨证与辨病相结合,运用现代中药药理研究的成果选择配伍中药和中药注射液,注重康复期的治疗,客观评价本病的临床疗效。结果：中医结合治疗视神经炎可提高其临床诊疗水平,减少或遏止并发症的发生发展。结论：以中医为主,中西医结合的研究思路是目前治疗视神经炎比较理想的手段。     

Mistaken diagnosis of optic neuritis and the possible role of phosphodiasterase-5 inhibitors (Sildenafil/Viagra)

The diagnosis of optic neuritis and particularly retrobulbar optic neuritis when atypical and not responsive to corticosteroid treatment may need to be revised. This is now especially so in male patients who should be questioned regarding their taking a phosphodiasterase-5 inhibitor in particular Viagra. The case history of such a patient is presented who sustained posterior ischaemic optic neuropathy mistaken for retrobulbar neuritis resulting in bilateral severe visual loss.     

6例确诊为多发性硬化的视神经炎临床分析

目的:探讨6例确诊为多发性硬化(MS)视神经炎的临床特点、治疗和预后等问题,以便更好地指导诊断和治疗。方法:连续收集2003年至2007年间在我院住院治疗的最后发展成为多发性性硬化的视神经炎患者6例,对其眼部表现、全身症状等进行回顾性分析。结果:我院同期住院治疗的视神经炎患者51例,6例最后发展为MS。6例发病年龄为16~62岁。其中3例为单眼发病,3例为双眼先后发病。发病时视力下降最低为无光感,最高为0.8,4例存在眼球转动时疼痛。瞳孔光反射在视力较好的两眼表现为正常,无光感1眼直接光反射消失,其余为迟钝。6只近期发病眼中有3只眼发病时为视盘炎,2只眼为球后视神经炎,1只复发眼表现为视盘颜色变淡;3只先前发作的均有视神经萎缩表现。其中3例检查血沉,结果为12~18mm/h,均正常范围。6例患者中有1例无眼外症状,第二次发病时行头部MR检查发现颅内多发病灶,确诊为MS。5例出现下肢无力等全身症状,其中4例检查脊髓MR发现病灶确诊,1例依靠病史诊断。结论:MS是视神经炎的常见病因之一,约占视神经炎的11.8%。因检查手段和观察时间等原因,这一比例应该更大。在我国多以脊髓损害为主。患病时年龄,视力下降程度,视乳头是否波及,有无眼部疼痛对判断视神经炎是否最终发展成为MS没有帮助。     

IDIOPATHIC INFLAMMATIONOF OPTIC NERVE SIMULATINGOPTICNERVE SHEATH MENINGIOMA

A case of idiopathic inflammation of optic nerve (perioptic neuritis) simulating optic nerve sheath meningioma is reported with a review of the litera- ture. Idiopathic inflammation of optic nerve causes the enlargement of optic nerve and sheath, the radio- logic feature of which may be fusiform or tubular uniformly diffuse thickening with a central hypo- dense area as is shown typically in this case (so- called tram-tracking sign). Idiopathic perioptic neuritis is an important condition in the differential diagnosis of visual loss when CT demonstrates en- Iargement of optic nerve.     

视神经炎患者首次接受大剂量激素冲击疗法的心理护理

目的 探讨护理干预对减轻视神经炎患者首次接受大剂量激素冲击疗法的不良心理反应的效果.方法 对88例首次接受大剂量激素冲击疗法的视神经炎患者的心理状态进行问卷调查,对冲击疗法前进行护理干预和未进行护理干预两组各44例进行比较.结果 首次接受大剂量激素冲击疗法前接受护理干预者的不良心理反应明显少于未接受护理干预者,并能积极主动配合治疗,情绪稳定,减少了因不良心理反应所产生的并发症.结论 实施护理干预能减轻视神经炎患者首次接受大剂量激素冲击疗法的不良心理反应,提高治疗的主动性和依从性.     

Early Diagnosis of Recurrent Optic Neuritis Using Contrast-Enhanced T2 Fluid-attenuated Inversion Recovery Imaging: a Case Report

The diagnosis of the recurrent optic neuritis is commonly established clinically, and sometimes it could be challenging because the involved optic nerve does not always show significant enhancement on conventional contrast enhanced-T1 weighted imaging (CE-T1WI). In this paper, we reported a middle-aged female with early diagnosis of recurrent optic neuritis using contrast-enhanced T2 fluid-attenuated inversion recovery imaging (CE-T2FLAIR). The involved optic nerve presented evident enhancement on CE-T2FLAIR and no enhancement on CE-T1WI. This case suggested that the CE-T2FLAIR may be a useful diagnostic tool specifically for the recurrent optic neuritis in clinical practice.     

Paraneoplastic optic neuropathy in nasopharyngeal carcinoma--report of a case

A 31-year-old Chinese man developed left optic neuritis with left sectorial field loss as a remote effect of nasopharyngeal carcinoma. The field defect showed interesting fluctuations in response to the dosage of systemic steroid therapy. Neuropathologic findings from an exploratory craniotomy did not show any gross tumour mass around the left optic nerve nor any histological evidence of tumour infiltration. This case illustrates that "optic neuritis" could be a paraneoplastic effect of nasopharyngeal carcinoma.     

特发性视神经炎类似视神经鞘脑膜瘤

放射学检查证实.有视神经和视神经鞘增大而视力丧失的病人多因肿瘤和非肿瘤疾病所致,视神经胶质瘤和视神经鞘脑膜瘤是视力丧失常见的原因.高分辨力薄层CT扫描能早期发现,并可鉴别这类病变.但许多非肿瘤性病变也可有肿瘤的同样CT表现.部份病例,很难根据各种视神经病变的大小、形态和造影剂增强的特性鉴别为肿瘤性或非肿瘤性肿块.     

过氧化氢酶与甲基强的松龙对实验性脱髓鞘性视神经炎的抑制作用

目的:研究活性氧簇清除剂过氧化氢酶(Catalase,CAT)及甲基强的松龙(Methylprednisolone sodium succinate,MP)琥珀酸钠对实验性脱髓鞘性视神经炎的作用及其机制.方法:将致敏大鼠分别以Catalase、生理盐水(Physiolosic saline,PS)及MP琥珀酸钠腹腔注射后分别于抗原致敏后第7 d及14 d,通过H_2O_2测定、病理图像分析、细胞组织超微结构分析等方法研究CAT及MP对实验性变应性视神经脊髓炎(Experimental autoimmune encephalomyelitis,EAE)大鼠视神经炎症损伤的作用.结果:EAE大鼠视神经H_2O_2含量较正常大鼠高,CAT和MP能减少EAE大鼠视神经H_2O_2含量,减轻炎症反应,抑制视神经的脱髓鞘,但MP对H_2O_2清除作用及髓鞘损害的保护作用较CAT弱.结论:H_2O_2可能和脱髓鞘性视神经炎的发病有一定关系.     

不同剂量甲基强的松龙与地塞米松治疗急性视神经炎疗效分析

目的：通过对不同剂量甲基强的松龙与地塞米松治疗急性视神经炎的研究,比较治疗急性视神经炎的治疗效果。方法：对62例共97眼急性视神经炎患者,随机分为3组,分别给予甲基强的松龙0.5g/d、1.0g/d,地塞米松10～15mg/d静脉滴注3～6d,随后均口服强的松40mg/d,根据视力及瞳孔反应情况缓慢减量,观察各组视力,瞳孔对光反应、相对性传入性瞳孔障碍程度和激素不良反应。结果：甲基强的松龙1.0g/d静滴治疗的急性视神经炎患者视力恢复比地塞米松快（P=0.046）,而甲基强的松龙0.5g/d静脉滴注治疗者视力恢复程度与地塞米松无统计学差异（P=0.103）。结论：甲基强的松龙1.0g静脉滴注治疗急性视神经炎效果较好,建议尽早给予患者使用大剂量激素治疗并维持较长的治疗时间。     

Bilateral optic neuritis in pregnancy

A 25-year old primigravida at 11-weeks period of amenorrhoea presented with bilateral optic neuritis following Varicella Zoster viral (VZV) infection. She was serologically positive for systemic lupus erythematosus but negative for virus. The exact pathogenesis of the patient's severe optic neuritis, adduction and neurological deficit was unknown. The initiation of high dose steroids for optic neuritis was a big clinical dilemma in a pregnant patient with viral infection. The patient was treated with high dose steroids after three days of commencement of antiviral treatment. At 6 months after presentation, her visual acuity in the right eye was 6/36 with perception to light in the left.     

还原型谷胱甘肽对实验性视神经炎视神经和视网膜的影响

目的 观察还原型谷胱甘肽(GSH)对实验性视神经炎视神经和视网膜的影响,并探讨其作用机制.方法 以48只雌性SD大鼠建立实验性变态反应性脑脊髓炎(EAE)动物模型,完全随机分为EAE组18只和GSH组30只,另6只雌性SD大鼠为正常组.免疫后当天开始,GSH组给予注射用GSH 100 mg·kg-1·d-1腹腔注射14 d,EAE组给予等量生理盐水替代.分别于发病初发期、高峰期、恢复期观察视神经病理学改变、视网膜神经节细胞(RGCs)凋亡,并检测视网膜丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH-PX)、一氧化氮(NO)的含量.结果 GSH组18只大鼠发病,发病率为60%,症状评分为1～3分;视神经HE染色见神经纤维排列较规则,胶质细胞较EAE组有所增加,脱髓鞘相对轻;RGCs凋亡数初发期和高峰期比EAE组减少,差异有统计学意义(P<0.01);视网膜MDA、NO含量下降,GSH-PX活力升高,与EAE组比较差异有统计学意义(P<0.05).结论 还原型谷胱什肽可降低EAE大鼠发病率和症状评分,抑制大鼠RGCs的凋亡,降低视网膜MDA、NO含量,提高GSH-PX活力,对实验性视神经炎的视神经和视网膜具有保护作用.     

视神经萎缩56例临床分析

通过对56例视神经萎缩患者进行原发病及诊断分析.结果颅脑眼外伤13例占23.21％,肿瘤12例占21.42%,视神经炎10例占17.85％,网膜中央动脉阻塞5例占8.92%,缺血性视神经病变4例占7.14％,青光眼3例占5.35%,视网膜色素变性2例占3.57%.Leber‘s病1例,原因不明6例。表明外伤、肿瘤及视神经炎所占比例较大。从诊断分析中显示肿瘤的误诊率最高达33.33%。提示对视神经萎缩原发病诊断要重视眼周围组织及全身检查以提高诊断水平。     

光学相干断层扫描仪在多发性硬化患者中的初步应用

目的：利用光学相干断层扫描仪（OCT）评估多发性硬化（MS）患者与正常人眼视网膜神经纤维层（RNFL）厚度和黄斑中心凹厚度及体积的差异,评估OCT监测MS患者病程中轴突缺失的意义。方法选取MS患者30例（60眼）,根据有无视神经炎（ON）发作史分为MS- ON组（41眼）和MS- NON组（19眼）,同时选择年龄和性别相匹配的健康体检者30例（60眼）为对照组。对3组受试者均进行详细的眼科检查,并使用OCT测定RNFL厚度和黄斑参数。采用单因素方差分析对3组的RNFL厚度、黄斑中心凹厚度和体积的差异进行分析。结果两组MS患者的RNFL厚度和黄斑参数与对照组均有统计学差异,MS- ON组和MS- NON组之间的RNFL厚度和黄斑参数也有差异（均P＜0.05）。结论 OCT可作为MS诊断的辅助检查手段。     

磁共振T2WI饱和脂肪抑制和弥散加权成像在诊断视神经炎中的应用

目的 研究磁共振T2WI饱和脂肪抑制和弥散加权成像(DWI)在视神经炎诊断中的作用.方法 回顾性分析经临床诊断为视神经炎患者17例,所有患者均行常规眼眶MRI轴位、矢状位成像及眶部冠状位T2WI脂肪抑制序列和横轴位DWI检查.结果 17例患者在眼眶常规MRI检查中视神经未发现病变,而在冠状位T2WI脂肪抑制序列中发现视...     

MRI Histogram Texture Feature Analysis of the Optic Nerve in the Patients with Optic Neuritis

Objective To evaluate the optic nerve impairment using MRI histogram texture analysis in the patients with optic neuritis.     

青光眼IOP与OPA相关性及其临床意义

目的 研究正常眼、视网膜脱离、视神经炎及青光眼患者的眼内压（intraocular pressure，IOP）与眼脉动振幅（ocular pulse amplitude，OPA）相关性特征。尝试根据不同类型青光眼患者OPA特征，协助早期诊断青光眼。方法 应用PASCAL动态轮廓IOP计，根据IOP波动规律，选择可匹配时间，随机测量正常眼28例（32眼）、视网膜脱离39例（42眼）、球后视神经炎7例（8眼）及青光眼患者61例（86眼）IOP与OPA值。急性闭角型青光眼前房穿刺后IOP与OPA值，运用SPSS13．0双变量相关分析软件分析正常眼、视网膜脱离眼及不同类型青光眼患者IOP与OPA相关性。结果 正常眼、青光眼患者IOP与OPA值均呈显著正相关（P〈0．01），相对正常眼，青光眼患者IOP与OPA显示相关系数更高。青光眼患者前房穿刺后，IOP下降伴随显著的OPA值下降，在眼压降至正常范围后，二者呈现密切的相关关系（r〉0.5），与正常人IOP与OPA关系有差异。视网膜脱离眼IOP与OPA值无明确相关性（r=0．328），视神经炎患者IOP与OPA负相关。结论 青光眼患者IOP与OPA显著相关性明确，即使IOP尚处于正常范围，也可以根据患者24h的IOP波动及其与OPA相关关系及门诊观察患者IOP与OPA的相关性，协助早期诊断青光眼。     

Clinics in diagnostic imaging (120). Right rhinogenic optic neuritis secondary to mucocoele of the Onodi cell

Acute visual loss can be caused by retrobulbar optic neuritis, radiation optic neuropathy or ischaemic optic neuropathy. Sinusitis affecting the Onodi cell, a posterior ethmoidal air cell that has encroached on the adjacent sphenoid bone forming the optic canal, can present rarely with visual loss. We report a 60-year-old man, who developed a sudden ache on the nasal aspect of his right eye, and deterioration of the vision in his right eye. This case illustrates the typical radiological appearances of the Onodi cell on MR imaging and CT. The diagnosis of right rhinogenic optic neuritis secondary to mucocoele of the Onodi cell was confirmed at surgery. Functional endoscopic sinus surgery with decompression of the Onodi cell was performed. Physicians should be familiar with the presentation, performed. Physicians should be familiar with the presentation, diagnosis and management of this rare but important condition.