颅内动脉瘤的眼部表现

颅内动脉瘤是神经系统常见的疾病,大部分动脉瘤破裂前通常无明显临床表现,破裂后常引起严重并发症,并危及患者生命.部分颅内动脉瘤可有眼部表现,如视乳头水肿、视网膜出血、玻璃体出血、视力下降、视野缺损、动眼神经麻痹、外展神经麻痹及三叉神经病变等.颅内动脉瘤的主要影像学诊断方法有电子计算机断层扫描、磁共振血管造影、数字减影血管造影,其中数字减影血管造影是诊断颅内动脉瘤的金标准.颅内动脉瘤主要依靠手术治疗,包括显微手术夹闭、血管内介入治疗,手术方式的选择应该根据病情及医疗条件综合考虑.     

颅内动脉瘤与眼科改变

随着颅内动脉瘤诊断技术的不断进步,越来越多的早期颅内动脉瘤患者被发现,避免了因动脉瘤破裂而导致的严重并发症的发生,为患者争取了宝贵的治疗时机,大大降低了疾病的致残率和死亡率。同时更多的颅内动脉瘤患者的临床症状与眼科有关,甚至可以是首发症状。详细了解颅内不同部位动脉瘤与眼科改变的密切关系有助于眼科医师及时捕捉颅内动脉瘤的相关信息,做到早发现、早诊断、早治疗。     

不同部位颅内动脉瘤与眼部症状的临床分析

目的 探讨颅内不同部位的动脉瘤引起眼部不同改变的应用解剖及临床表现.方法 回顾性分析近10年在解放军总医院神经外科和介入科确诊为颅内动脉瘤的232例患者,对其中有眼部改变的46例进行综合分析.结果 在46例颅内动脉瘤患者中,后交通动脉瘤有24例(占52.1%),海绵窦段动脉瘤9例(占19.57%),发动脉瘤4例(占8.70%),小脑上动脉瘤3例(占6.52%),颈内动脉瘤2例(占4.34%),前交通动脉瘤2例(占4.34%),大脑前动脉瘤2例(占4.34%);在受累及的颅神经中,动眼神经最多,有31例(占67.39%),其次为视神经7例(占15.22%),外展神经和三叉神经各6例(占13.04%),滑车神经最少,有2例(占4.35%);因眼肌麻痹、复视到眼科首诊的有9例(占19.56%).结论 颅内不同部位的动脉瘤可引起相应的眼部改变,有一定相关性,但无明显特异性,与瘤体位置、大小、形状、生长方向有关.     

以眼部症状为首发的颅内动脉瘤2例

颅内动脉瘤是神经系统常见疾病 ,发病率为 0 9% 〔1〕。部分颅内动脉瘤的首发症状表现在眼部 ,因此能够识别颅内动脉瘤对眼科医生至关重要。本文介绍 2例于眼科首诊的颅内动脉瘤病例。例 1　女性　 65岁　无明显诱因突然出现左眼剧烈疼痛、伴头痛、恶心、呕吐。左眼视力 0 2 ,左眼上睑下垂 ,球结膜充血 ,角膜无水肿。前房深浅正常 ,前房角为宽角 ,瞳孔直径 8ｍｍ ,对光反应消失 ,其余眼内结构未见异常。左眼球固定 ,各方向运动均障碍。左眼压 34ｍｍＨｇ。右眼前节及眼底正常。右眼压 14ｍｍＨｇ。疑诊头颅疾病 ,拍摄头颅核磁共振(ＭＲＩ)…     

以动眼神经麻痹为首发的颅内动脉瘤一例

颅内动脉瘤是神经系统常见疾病,发病率为0.9%[1]。部分颅内动脉瘤的首发症状表现在眼部,因此能够识别颅内动脉瘤对眼科医生至关重要。李××女53岁2005年4月27日以左眼动眼神经麻痹入院。查血糖5mmol/L,血压120/80mmHg。双眼视力均为1.0,双眼眼压均正常。左眼上睑完全不能睁开,眼球向上、下、内不能转动,结膜充血,余未见明显异常。头部CT及MRI均未见明显异常,建议其行DSA检查,因向有危险性,患者拒绝。行抗炎、抗病毒治疗,地塞米松结膜下注射。治疗5天后症状无明显好转,患者同意行数字减影脑血管造影检查(DSA)。回报:大脑后交通动脉上…     

颅内动脉瘤眼部表现的临床分析

目的：探讨颅内动脉瘤引起的眼部病变。方法：回顾近5年来在我院神经科住院并确诊为颅内动脉瘤的39例患者的临床资料，对其引起的眼部病变进行着重分析。结果：39例中有眼部改变者22例（56.41％）。22你（22只眼，56.41％）均有眼肌麻痹；伴有视力下降者8例（8只眼，20.51％）；眼球及眼眶疼痛者8例（8只眼，20.51％））；眼底改变者3例（4只眼，7.69％）；视野缺损者2例（4只眼，5.13％）；角膜反射减弱者2例（2只眼，5.13％）；流泪者1例（1只眼，2.56％）；眼睑皮肤感觉下降者1例（1只眼，2.56％）。以上睑下垂、复视为主诉到眼科首诊的患者有9例（23.08％）。结论：颅内动脉瘤可引起眼部多种病变，其中最常见的病变为眼肌麻痹。     

单眼急性瞳孔扩大的临床意义

颅内动脉瘤是脑出血、蛛网膜下腔出血的主要原因之一。颅内动脉瘤早期约20％的患者有眼部表现，急性瞳孔扩大是其重要体征之一。眼科医生对这一体征的及早识别有可能使患者得到及时救治，并挽救生命。本文从解剖学、病因学、诊断学等方面复习了单眼瞳孔急性扩大的各种可能及病理情况，特别强调了单眼急性瞳孔扩大与颅内动脉瘤的关系及临床意义。（眼科，2009，18：77-79）     

单侧后交通动脉瘤患者眼部表现观察

后交通动脉瘤(PCOAA)在我国的颅内动脉瘤中所占的比率居第一位[1,2],许多患者有眼部表现,甚至首诊于眼科.但不少眼科医师对此认识不够充分,而颅内动脉瘤又是一种急症,有潜在致命风险.     

颅底动脉瘤的眼部改变

报告１４６例颅底动脉瘤的眼部改变，常见为头痛、眼痛、视力减退、复视、上睑下垂。颅神经麻痹以动眼神经最易受累，外展神经次之，滑车及三叉神经最少。动眼神经麻痹时最常见的表现为提上睑肌及瞳孔纤维受累。视交叉附近动脉瘤的视野改变均不呈现典型的颞侧偏盲。     

颅内动脉瘤合并视野缺损的诊断分析

目的 探讨颅内动脉瘤合并视野缺损在眼科诊断的分析.方法 回顾近4年确诊为颅内动脉瘤合并视野缺损的12例患者,其中大脑前动脉动脉瘤5例,前交通动脉瘤4例,颈内动脉动脉瘤3例,对此进行分析.结果 12例均以视野缺损为首发症状,误诊为缺血性视神经疾病9例、球后视神经炎2例、正常眼压型青光眼1例,结论对于视野缺损患者应进一步检查,必要时做脑血管数字减影血管造影(DSA),以防误诊误治.     

Ophthalmic involvement in nasopharyngeal carcinoma

This article desribes the ophthalmic involvement in patients with nasopharyngeal carcinoma (NPC) pre- and post-treatment. We retrospectively reviewed data for 354 consecutive patients diagnosed with or treated for NPC at a single tertiary centre between April 2007 and July 2015. We identified 27 (7.6%) patients with ophthalmic involvement due to NPC or its treatment. Symptomatic orbital invasion by tumor occurred in 13 of 27 patients (48.1%). The mean age of diagnosis in these patients was 54 years, and 8 (61.5%) had no prior diagnosis of NPC. Ocular signs, but no orbital invasion, was present in 8 patients (29.6%). Incidental orbital involvement was detected on imaging in 2 patients (7.4%). Radiotherapy-related ocular complications affected 4 patients (14.8%). Ophthalmic symptoms from orbital invasion can be the initial presentation of NPC. This disease tends to affect a younger group of patients and early recognition is important to minimize morbidity and mortality.     

Central nervous system involvement after herpes zoster ophthalmicus

Purpose: To report central nervous system involvement after varicella zoster virus infection. Methods: We evaluated the frequency and type of neurological complications in patients initially presenting with ophthalmic herpes zoster at an ophthalmological department in a Danish university hospital, over a 7‐year period. Results: Of the 110 immunocompetent patients who presented with initial ophthalmic zoster, six (5.5%) suffered from neurological complications other than post‐herpetic neuralgia. Four experienced isolated cranial motor nerve palsies, one patient had meningitis with a favourable outcome and one patient had severe encephalitis with a poor clinical outcome. Conclusions: Central nervous system involvement after varicella zoster virus infection is an uncommon, but potentially life‐threatening, complication. Early recognition of neurological complications prompts acute, appropriate antiviral treatment.     

First a third, then a fourth nerve palsy in multiple intracranial aneurysms

Background Intracranial aneurysms may be a cause of ocular motor dysfunction, the third nerve being more often involved than the two other cranial ocular motor nerves. Methods We report the unusual occurrence of an isolated fourth nerve palsy related to a cavernous carotid aneurysm, angiographically confirmed. The patient already underwent clipping of a ruptured posterior communicating artery aneurysm 17 years earlier, revealed at that time by a third nerve palsy. Results Endovascular treatment of the cavernous carotid aneurysm was performed, resulting in complete recovery of the palsy. Conclusion Occurrence of an acquired fourth nerve palsy in a patient with a past history of aneurysm should prompt neurovascular imaging as multiple aneurysms may cause sequential ocular motor palsies.     

Ophthalmic manifestations of head injury

Head injuries are frequently associated with ophthalmic problems. The commonest problems seen in this series of 161 patients with head injury were problems with poor accommodation (16% of patients; 58% of these persisted), convergence (14% of patients; 35% of these persisted), pseudomyopia (19%; 55% persisted) and optic atrophy (26% of the patients; 78% of these were mild and easily missed on routine testing, and 22% were severe).
Motility disorders were common, especially cranial nerve palsies. Other less frequent motility disturbances included apparent inferior oblique palsy, comitant esotropia, and exotropia which was often of the convergence insufficiency type.     

Computed Tomography Angiography of Bilateral Intracavernous Internal Carotid Artery Aneurysms

Bilateral intracavernous internal carotid artery aneurysms are rare. They are more common in elderly females and are associated with hypertension. We present the computed tomography angiography findings of an 81-year-old female with history of hypertension who came complaining of diplopia and headache. Examination revealed bilateral sixth nerve palsy with left third nerve palsy. External ocular examination was normal. Computed tomography angiography was done and revealed bilateral intracavernous internal carotid artery aneurysms. She was referred to neurosurgery for further management.     

COVID-19 and Eye: A Review of Ophthalmic Manifestations of COVID-19

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had health implications of unprecedented magnitude. The infection can range from asymptomatic, mild to life threatening respiratory distress. It can affect almost every organ of the body. Ophthalmologists world over are reporting various manifestations of the infection in the eye. This review was undertaken to help ophthalmologists recognize the possible manifestations and the stage of the viral disease when they commonly appear. Literature search was performed for the publications on ophthalmic manifestations of coronavirus disease-19 (COVID-19) between January 1, 2020 and January 31, 2021. 46 case reports, 8 case series, 11 cross sectional/cohort observational studies, 5 prospective interventional studies, 3 animal models/autopsy studies and 6 reviews/meta-analysis were included. Conjunctivitis is the most common manifestation and can develop at any stage of the disease. Direct effect due to virus, immune mediated tissue damage, activation of the coagulation cascade and prothrombotic state induced by the viral infection, the associated comorbidities and drugs used in the management are responsible for the findings in the eye. The viral ribonucleic acid (RNA) has been isolated from ocular tissues but the role of eye as a route for infection is yet to be substantiated. Ophthalmic manifestations may be the presenting feature of COVID-19 infection or they may develop several weeks after recovery. Ophthalmologists should be aware of the possible associations of ocular diseases with SARS-CoV-2 in order to ask relevant history, look for specific signs, advise appropriate tests and thereby mitigate the spread of infection as well as diagnose and initiate early treatment for life and vision threatening complications.