空蝶鞍综合征的眼底表现

目的 分析脑部磁共振检查（MRI）示空蝶鞍综合征患者的眼底表现.设计回顾性病例系列.研究对象经脑部MRI检查后诊断为＂空蝶鞍＂及＂部分空蝶鞍＂患者22例.方法 回顾性分析了2009年12月25日至2010年2月8日于北京同仁医院接受脑部MRI检查后发现＂空蝶鞍＂患者22例,均行眼底立体照相,分析患者临床表现、MRI诊断及眼底立体照相所见.主要指标临床表现及眼底照相所见.结果 22例患者中,以头晕为主诉者3例（13.64%）;以头痛为主诉者4例（18.18%）;以视力下降为主诉者6例（27.27%）;以视野缺损为主诉者4例（18.18%）.眼底立体照相发现1例患者左眼视网膜血管高度迂曲、扩张;2例患者双眼视乳头水肿;1例患者单眼视乳头水肿;1例患者双眼视乳头水肿伴视网膜水肿、放射状皱褶.结论 原发性空蝶鞍综合征患者最常见的临床表现是视力下降、视野缺损、头晕、头痛.眼底表现主要为视乳头水肿.     

空蝶鞍综合征的眼部临床症状分析1例

0引言空蝶鞍综合征系因鞍隔缺损或垂体萎缩、蛛网膜下腔在脑脊液压力冲击下突入鞍内,致蝶鞍扩大、垂体受压而产生的一系列占位性症状及内分泌改变的一组综合征[1]。我们报告1例空蝶鞍综合征出现眼部症状的病例,供眼科同道临床工作中借鉴参考。1病例报告患者,男,44岁,因双眼视力下降6mo就诊。6mo前无明显诱因患者自感双眼视物模糊,未予重视,以后双眼视力下降加重,即到当地医院治疗,曾做CT示:鞍区占位。MRI示:空蝶鞍综合征。于2009-08-24来我院就诊,全身体检未见明显异常。眼科检查:右眼CF/20cm,左眼0.2(矫无助)。右眼外斜40°,角膜有一云翳,前房中等深度,瞳孔圆,直径3.5mm,对光     

多发性周围神经病变-脏器肿大-内分泌障碍-M蛋白血症-皮肤病变综合征患者的眼部特征分析

目的研究多发性周围神经病变-脏器肿大-内分泌障碍-M蛋白血症-皮肤病变综合征（POEMS）患者的眼部特征并探讨其发生机制。方法回顾性分析1984至2004年确诊的15例POEMS综合征患者的临床表现、眼部特征及颅内压情况等。结果15例（30只眼）中,有3例双眼视力轻度下降;7例双眼早期轻度视乳头水肿;5例完全视乳头水肿,其中4例（5只眼）有视乳头边缘或附近视网膜前的小片出血。11例进行了至少1次脑脊液压力的测定,其中7例视乳头水肿患者伴有颅内压升高。结论POEMS综合征患者眼部主要表现为双眼视乳头水肿,发生率约为80．0％,视乳头水肿患者大多伴有颅内压升高。（中华眼科杂志,2005,41：917-919）     

抗磷脂综合征表现为视乳头水肿1例

目的:报告1例罕见抗磷脂综合征的患者,由于上矢状窦血栓形成而表现为双眼视乳头水肿及右眼第六颅神经麻痹,经抗凝和乙酰唑胺治疗后视乳头水肿恢复。方法:病例报告:一44岁中国男性,主诉为头痛、复视及轻度的视物模糊。临床检查发现右眼第6神经麻痹和双眼视乳头水肿,双眼视野盲点扩大和红绿色觉缺失,计算机断层摄影及核磁共振扫描显示上矢状窦血栓形成,血液学检查证实抗磷脂综合征是其潜在原因。结果:在联合应用抗凝和口服乙酰唑胺治疗3mo后,视乳头水肿恢复至正常的解剖,扩大的视野盲点降至正常水平,双眼红绿色觉恢复正常,伴随右眼视乳头水肿消退和视力改善表明这个患者视功能得以恢复。结论:抗磷脂综合征应与视乳头水肿鉴别诊断;对于顽固性的视乳头水肿,口服乙酰唑胺是抗凝治疗的重要辅助治疗,它可以保护视神经免受有可能导致失明后果的视神经损害。     

空泡蝶鞍综合征一例

空泡蝶鞍综合征因颅片无特征性改变,使治疗无针对性,以致双眼短时间内失明,在眼科临床上尚不多见,现报告1例。李某,女,42岁。2 0 0 3年9月10日因头痛伴视物模糊1周在外院眼科就诊。眼科检查:视力右眼0 5 ,左眼0 6,矫正视力不提高。眼球运动正常,眼前节正常,晶状体透明。眼底视乳头水肿伴出血。眼压:16mmHg( 1mmHg =0 13 3kPa)。头颅CT平扫示:双侧基底节区及放射冠见斑点状低密度影,脑室系统不大,诸脑裂脑沟不宽,脑中线结构居中,诊断为多发性腔隙性脑梗塞。临床诊断:视乳头水肿,未予治疗。9月2 5日脑MRI未见异常,双眼视野向心性缩小2 …     

视乳头周围视网膜下新生血管膜所致假性视乳头水肿

作者报告一例典型的老年性黄斑变性合并视乳头明显隆起,作者认为这样的病例应与视乳头水肿鉴别。患者女性76岁于1979年10月右眼行白内障囊内摘出术并植入人工晶体,术后视力不佳。1980年2月取出人工晶体。同时左眼做白内障囊内摘出术。1980年6月患者主诉2个月来双眼视力下降。检查:矫正视力右20/60,左眼20/30。右眼虹膜后粘干玻璃体表面而致瞳孔不规则。裂隙灯检查前房内KP及闪光均为阴性。无玻璃体疝。眼底所见:双眼老年性黄斑变性,右眼有视网膜出血,双眼有玻璃疣。左眼视乳头显水肿。患者体健,未服用药物。眼底荧光血管造影检查:显示双眼黄斑部有新生血管膜,左眼视乳头着染尤以鼻侧明显。神     

空泡蝶鞍症2例

空泡蝶鞍症是由于鞍隔缺损或垂体萎缩,随之蛛网膜下腔疝入鞍内,导致蝶鞍扩大、腺垂体和视交叉受压,从而产生一系列症状。该病在临床上十分少见。近年来随着电子计算机断层扫描、核磁共振显象术等影象诊断技术的应用,空泡蝶鞍症有增多趋势。例1 梅××女48岁住院号54400 1988年4月,患者在体检时偶然发现双眼视乳头水肿,遂收住院检查。近2个月,自觉双眼眶偶有胀痛,右眼前有黑影飘动。全身无何不适。既往无特殊病史。血压114/76mmHg,常规体检正常。血糖、血脂正     

视神经肿瘤36例临床分析

分析视神经源性肿瘤患者的病史、临床表现、影像学检查和治疗方法,为其诊断和治疗提供帮助。 方法：对视神经胶质瘤和视神经鞘脑膜瘤患者的临床资料进行分析。 结果：视神经胶质瘤的15例患者中以发现眼球突出为主诉的病例为6例,以发现视力下降为主诉的5例,眼球突出合并视力下降的2例;视神经鞘脑膜瘤组21例患者中以眼球突出为主诉的病例为13例,视力下降5例,眼球突出合并视力下降的3例。超声检查、CT、MRI检查均有典型表现;30例患者经手术治疗,6例经伽玛刀治疗。 结论:视神经源性肿瘤在眼部检查及影像学表现上有一定的特征性,对于辅助诊断具有重要价值;治疗方案应视患者的具体情况综合制定,目前以手术及放射治疗为主。     

原发性空蝶鞍综合征及探讨性治疗

目的 观察分析原发性空蝶鞍综合征的眼部临床特征，并通过治疗，探讨其治疗方案，以保存患者的视力。方法 回顾本院发现的3例原发性空蝶鞍综合征的临床表现，跟踪观察，予保守治疗。结果 1例合作者治疗有效，2例拒治者1只眼失明，2只眼即将失明。结论 原发性空蝶鞍综合性通过头颅X线、CT、MRI易诊断，但眼部观察及治疗报告甚少，早期及时药物治疗能稳定病情，防止失明。     

双眼特发性黄斑囊样水肿4例

我们报告4例双眼特发性黄斑囊样水肿(CME)的临床表现、眼底血管荧光造影和干涉光断层扫描(OCT)检查结果。患者均为男性,年龄30 ～52岁之间。均以双眼视物不见1wk主诉就诊。眼底检查显示双眼后极部黄斑水肿。荧光造影检查结果显示:1例未见特异性改变;其余可见典型的花瓣状图像。OCT检查均见视网膜下积液。所有患者均按特发性黄斑囊样水肿之诊断治疗,6wk后,视力提高。     

Empty sella turcica and papilloedema (author's transl)

In a 49-year-old patient bilateral papilloedema with an empty sella turcica was observed. A summary of the literature references to this syndrome and its pathogenesis and its eye complications are given and discussed.     

Down but not out

A 20-year-old Hispanic man with Down syndrome presented with progressively worsening headache, fluctuating decreased vision, and bilateral optic disk edema. Magnetic resonance imaging of the head showed an empty sella, and magnetic resonance venography showed thrombosis of left transverse and sigmoid sinuses. Catheter angiography angiogram showed a dural arteriovenous fistula in the wall of left transverse and sigmoid sinuses. The patient underwent Onyx endovascular embolization of the fistula, resulting in its angiographic obliteration, followed by resolution of his clinical signs and symptoms.     

Morning glory syndrome associated with posterior pituitary ectopia and hypopituitarism

PURPOSE: To report a patient with morning glory syndrome in combination with posterior pituitary ectopia and to emphasize the need for early recognition of this syndrome as an important step towards the diagnosis and treatment of the systemic anomalies that may be associated with it. METHODS: We present a 7-year-old boy who showed short stature, nystagmus, inward deviation and low vision. Ophthalmological and general physical examinations, further endocrine evaluation and magnetic resonance imaging (MRI) of the brain and sella turcica were performed. RESULTS: Both fundi showed symptoms of morning glory syndrome. The discs were pink and deeply excavated, and were surrounded by a ring of chorioretinal pigmentary disturbance. Magnetic resonance imaging revealed the absence of the infundibulum and posterior pituitary ectopia. Growth hormone studies confirmed the diagnosis of growth hormone deficiency. Therapy with recombinant human growth hormone was initiated. CONCLUSIONS: Although most cases of morning glory syndrome occur as isolated ocular abnormalities, it may occur in association with systemic anomalies, including posterior pituitary ectopia and hypopituitarism. A complete general physical examination and growth evaluation is important for early detection and treatment, resulting in benefit for these patients.     

Case of Primary Leptomeningeal Lymphoma Presenting with Papilloedema and Characteristics of Pseudotumor Syndrome

The authors describe an immunocompetent, 50-year-old man who complained of a daily transient blurring of his vision with bilateral papilloedema. His visual acuity was 20/20 OU, and the blind spot was enlarged bilaterally. There was intracranial hypertension, but imaging for systemic and brain tumours were negative. These findings suggested a diagnosis of the pseudotumor syndrome. However, MRI showed leptomeningeal enhancement, and acetazolamide successfully resolved his visual symptoms and papilloedema. Cytology and flow cytometry of the CSF led to the final diagnosis of primary leptomeningeal lymphoma (PLML). Clinicians need to be aware that a case of PLML may be misdiagnosed as peudotumor cerebri.     

Diagnosis of the empty sella with intrathecal metrizamide computed tomography

The empty sella syndrome can be diagnosed with high resolution computed tomography. The addition of intrathecal metrizamide defines the degree of extension of the subarachnoid space into the sella turcica, demonstrates the relationship of surrounding structures, and differentiates the empty sella from other isodense or hypodense intrasellar lesions. Photographs from a case of primary empty sella demonstrate the details of anatomy seen with metrizamide computed tomography combined with sagittal reconstruction.     

空蝶鞍综合征眼部特征分析

目的  探讨空蝶鞍综合征的眼部临床表现及预后。设计 回顾性病例系列。研究对象 在北京同仁医院就诊,经MRI检查诊断为空蝶鞍综合征的32例患者。方法  对这些患者的检查治疗资料及眼部表现进行分析。主要指标 视力、眼压、眼底、视野、房角。结果 32例患者中因明显视力下降就诊者20例（62.5%）。最佳矫正视力低于0.8者45眼,其中低于0.1者5眼,0.1~0.3者14眼,0.4~0.7者26眼。眼压在21~29 mm Hg者13眼（20.3%）。眼底检查13眼（20.3%）有视盘水肿,19眼（29.7%）有视神经萎缩。视野缺损48眼（75.0%）,其中9眼有类似青光眼的视野缺损,10例患者为双颞侧偏盲。房角开放者28例56眼（87.5%）,房角窄或可疑关闭者4例8眼（12.5%）。3例空蝶鞍综合征患者合并闭角型青光眼,1例合并开角型青光眼,2例合并正常眼压性青光眼。3例患者经神经外科手术治疗,最佳矫正视力好转。结论 空蝶鞍综合征的眼部表现可有视力下降、视盘水肿、视神经萎缩及视野缺损。对于不能由眼科疾病解释而怀疑本病者,应及时请相关科室会诊并协助治疗。（眼科, 2012, 21: 309-312）     

Pachymeningitis with pseudo-Foster Kennedy syndrome

PURPOSE: To report a case of pachymeningitis with pseudo-Foster Kennedy syndrome in a patient who was positive for perinuclear antineutrophil cytoplasmic antibody. METHODS: Case report. A 44-year-old man was examined for headache and diplopia. RESULTS: Left eye showed limitation of abduction. Ocular fundus, computed tomography (CT), and magnetic resonance imaging (MRI) of the head and orbits were normal. The diplopia subsided spontaneously. Six months later, he noticed sudden visual loss in the left eye. The left eye showed optic disk atrophy and episcleritis, and the right eye showed papilloedema. Computed tomography and MRI exhibited thickened dura mater. Serum perinuclear antineutrophil cytoplasmic antibody level was highly increased. CONCLUSION: Pachymeningitis with ocular involvement sometimes requires repeated CT or MRI for diagnosis. This disorder may be caused by microvasculitis.     

The intracranial hypertension in the course of Arnold-Chiari malformation

PURPOSE: The aim of this study was to remind the symptoms and diagnostic methods helpful to recognize Arnold Chiari syndrome. MATHERIAL AND METHODS: We have presented a 53-year-old woman with papilledema who was operated and treated oncologically because of right breast tumor - four years ago. As a result of diagnostic research which took into consideration a brain magnetic resonance imaging (MRI), the suspicion of metastatic cerebral tumor was excluded and Arnold - Chiari malformation was diagnosed. CONCLUSIONS: The intracranial hypertension and it's ocular manifestation - papilloedema may be caused by different, also congenital, reasons. The brain MRI is the mainly procedure to diagnose the Arnold - Chiari malformation.     

An orbital hydatid cyst involving inferior rectus muscle: A case report

The orbital hydatid cyst is a rare entity and although most of them are located in superolateral and superomedial angles of orbits, involvement of inferior sites is uncommon. We report a 12-year-old case of primary hydatid cyst situated in inferior rectus muscle which was undergone surgical removal. Magnetic resonance imaging (MRI) was used for differential diagnosis of hydatid cyst. Moreover, histological analysis was performed, after the cyst removal, to confirm the diagnosis. Early clinical and radiological evaluations and subsequent surgical excision is the mainstay of treatment and should be performed to prevent severe complications caused by the advanced and ruptured cysts.

Abbreviations: MRI: magnetic resonance imaging; CNS: central nervous system; BCVA: best corrected visual acuity; CT: computed tomography; USG: ultrasonography