Long time echo STIR sequence magnetic resonance imaging of optic nerves in optic neuritis

Magnetic resonance images of optic nerves were obtained in 20 patients with acute optic neuritis (ON), and assessed by means of clinical, visual field and visual evoked potential evaluations; the imaging was repeated 1 year later. The results of the conventional Short Tau Inversion Recovery (STIR) sequence obtained using short time echo (STE-STIR: 22 msec) were compared with those of the long time echo sequence (LTE-STIR: 80 msec). The conventional STE-STIR sequence revealed lesions in 57.2% cases of acute ON and in 42.9% of the optic nerves affected by previous ON: the LTE-STIR sequence was diagnostic in 95.2% of acute ON cases and in 85% of patients with previous ON. The calculated length of the optic nerve lesions was significantly longer in the images obtained using the LTE-STIR sequence than in those obtained using conventional STE-STIR sequences.

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Sommario Si descrivono i risultati ottenuti con indagini di Risonanza Magnetica (RM) dei nervi ottici (eseguite all'esordio e 12 mesi dopo) in 20 pazienti affetti da Neurite Ottica (NO) acuta, valutata in funzione della sintomatologia clinica e delle alterazioni campimetriche e del potenziale evocato visivo.Sono state analizzate le immagini RM in Short Tau Inversion Recovery (STIR) mettendo a confronto i rilievi ottenuti con sequenza Short Time Echo (STE-STIR: 22 msec) rispetto a quelli ottenuti con Long Time Echo (LTE-STIR: 20 msec). Mentre con la convenzionale STE-STIR è stato possibile rilevare lesioni a carico dei nervi ottici nel 57.2% delle Neuriti Acute e nel 42.9% delle Neuriti Pregresse, la metodica LTE-STIR è risultata diagnostica nel 95.2% delle Neuriti Acute e nel 85% delle Neuriti Pregresse.Sia nelle NO acute che nelle pregresse, la lunghezza delle lesioni a carico dei nervi ottici sono risultate significativamente maggiori rispetto a quelle ottenute con la convenzionale metodica STE-STIR.

     

针刺对实验性变态反应性神经炎TNF-α和IL-4的影响

目的 探讨肿瘤坏死因子-α(TNF-α)和白细胞介素-4(IL-4)与实验性变态反应性神经炎(EAN)发病的关系，从细胞因子水平研究针刺疗法对本病的免疫调节作用。方法 40只大鼠分为正常对照组、模型组、针刺组、药物组，建立大鼠EAN动物模型，观察大鼠发病率及致病程度，针刺组取腰。夹脊、足三里、悬钟穴，药物组用泼尼松灌胃给药。采用双抗体夹心ELISA法，检测大鼠血清的TNF-αa和IL-4的含量变化。结果 模型组TNF-α含量较正常组明显升高。针刺组和药物组均能降低TNF-α的含量，使其水平接近正常，尤以药物组抑制作用明显。IL-4的含量各组间均无明显差异。结论 提示本病存在Th1／Th2细胞因子间的失衡，其中以Th1型细胞占优势。针刺主要是通过抑制TNF-α等Th1细胞，来重建细胞因子间的平衡。     

Steriods for multiple sclerosis and optic neuritis: a meta-analysis of randomized controlled clinical trials

We conducted a meta-analysis of randomized controlled clinical trials on steroid treatment for multiple sclerosis and optic neuritis. Of the 25 trials comparing steroids and controls without steroid treatment that we identified 12 were selected for this review. A meta-analysis was conducted to calculate the overall odds ratio across the studies for the numbers of patients without functional improvement and with new relapses. The trials included a total of 1714 patients: 998 with multiple sclerosis and 716 with optic neuritis. Any type of corticosteroids or adrenocorticotropic hormone (ACTH) treatment was considered, as was any dosage, route of administration, and length of treatment. Main outcome measures were: (a) number of multiple sclerosis patients who did not improve by at least one point on the EDSS or equivalent scale, or number of optic neuritis patients without complete recovery of visual acuity at 8 or 30 days and at longer follow-up; (b) number of multiple sclerosis patients with at least one new relapse, or number of optic neuritis patients in whom definite multiple sclerosis was diagnosed at longer follow-up. We found that corticosteroids or ACTH produced a significant improvement in disability or visual acuity at 30 days (odds ratio 0.49; 95 % CI 0.37–0.64). The improvement was not statistically significant at longer follow-up (0.85; 95 % CI 0.67–1.09). The treatment did not significantly reduce the number of patients with relapses (0.74; 95 % CI 0.54–1.01). Both low and high doses were effective for 30-day improvement, but only high-dose and short-term therapy were factors that identified subgroups with some reduction in the risk of new relapse. However, the power of the statistical analysis to detect a reliable difference in the subgroups was low. Steroid treatment is therefore effective in accelerating short-term recovery in patients with multiple sclerosis or optic neuritis. Whether steroids are also effective in reducing the risk of relapse, and the optimal dose and length of treatment must still be determined. Received: 5 August 1999, Received in revised form: 29 December 1999, Accepted: 22 January 2000     

内窥镜鼻内视神经管减压治疗重症球后视神经炎

目的 观察内窥镜经鼻内视神经管减压治疗重症球后视神经炎的疗效.方法 回顾分析1995年-2007年经眼科药物治疗16-20d其疗效欠佳转来我科的10例16眼资料(其中4例单眼,6例双眼),仅对视力极差的10例10眼施行减压治疗.结果 对10眼视力无光感-30cm数指减压治疗.术后继续药物治疗16-20d,视力恢复到0.3-0.7.经1-8年观察视力0.5-1.0,眼底视乳头色泽正常,而未手术的6眼,视力无光感-20cm数指,眼底视乳头苍白萎缩,血管细小,呈鲜明对比,疗效迥然不同.结论 经眼科药物治疗16-20d,视力仍无光感-眼前数指,CT,MRI检查,排除颅内病变而球后视神经明显增粗的重症病例,应行减压治疗,可恢复较好的视力.     

特发性视神经炎患者视盘及黄斑区血流密度的定量研究

目的：评估特发性视神经炎(ON)患者的患眼和未受累对侧眼的视盘及黄斑的血流密度改变情况,为特发性ON的治疗和随访提供一定的临床指导。

方法：横断面研究。收集2019-12/2021-12于扬州大学附属苏北人民医院眼科确诊的初次发病且病程≤3 mo的单眼特发性ON患者16例,分为患眼组16眼与未受累对侧眼组16眼,另收集性别、年龄相匹配的健康者20例20眼作为对照组。所有眼均行视盘区4.5 mm×4.5 mm及黄斑区6 mm×6 mm光相干断层扫描血管成像(OCTA)检查,收集视盘区及黄斑区各血流指标,并对三组间各指标进行对比及分析。

结果：与对照组及未受累对侧眼组相比,ON患眼组视盘全区域及视盘周围各分区毛细血管、全部血管血流密度均降低(P<0.05)。与未受累对侧眼组相比,ON患眼黄斑区整体及中心凹周围全部分区SCP血流密度均显著降低(P<0.05),旁中心凹SCP血流密度仅在上半侧及上侧分区显著降低(P<0.05)。与对照组相比,ON患眼组黄斑中心凹周围下半侧、鼻侧、下侧SCP密度降低(均P<0.05)。与对照组相比,未受累对侧眼组黄斑区整体及各分区SCP血流密度均增加(P<0.05),旁中心凹SCP血流密度增加(P<0.05),但下半侧、鼻侧分区改变无统计学差异(P>0.05),中心凹周围SCP血流密度增加仅在上半侧及上侧分区有统计学意义(P<0.05)。

结论：病程3 mo以内的ON患者会出现视盘周围各分区血管密度的降低和黄斑中心凹周围部分分区SCP血流密度的降低,同时伴随着对侧眼黄斑区部分分区的SCP血流密度的增加。     

磁共振成像、视诱发电位和视野检查在视神经炎的临床应用

目的 探讨MRI、视诱发电位(VEP)和视野(Vision Field，VF)在视神经炎中的临床应用价值。方法 临床诊断为视神经炎者60例分别行MRI、VEP和视野检查，每例所有检查均在一周内完成，并将检查结果进行统计学处理和分析。结果 MRI阳性率最高(96．67％)，其次是视野和VEP(86．96％和75．58％)。同时发现MRI具有定位和一定的鉴别诊断作用。结论 VEP和VF结合MRI检查，三者相辅相成，将有助于视神经炎更早、更准确地诊断和治疗。     

视神经周围炎的研究进展

视神经周围炎(OPN)是指涉及视神经鞘膜的一系列病理性炎症.OPN的经典三联征包括单侧视神经病变伴随疼痛和/或视盘水肿,此病症与其它视神经病变相似,导致诊断延迟和治疗欠佳.2016年1月,我们对发表于Medline和Ovid数据库的关键词为“视神经周围炎”的各种语言的文献进行了检索,共查找到60篇文献,发表于1956-2015年.两位作者(Tai ELM和Tevaraj JMP)分别对论文摘要进行了独立筛选,并筛选出相关文章.本次综述,我们强调OPN的特点,特别是OPN和视神经炎之间的临床差异.虽然大多数OPN的病例是特发性的,但仍需进行调查以排除特异性感染和继发性OPN的炎症原因.MRI是非常重要的检查方法,由于OPN视神经周围炎症的影像学诊断.糖皮质激素治疗可使症状与体征迅速好转,长期口服糖皮质激素并慢速递减可以降低复发的风险.     

补阳还五汤、针灸拔罐联合甲钴胺穴位注射治疗面神经炎的近、远期临床观察

目的 探讨补阳还五汤、针灸拔罐联合甲钴胺穴位注射治疗面神经炎的临床疗效.方法 选取2019年2月—2020年2月收治的46例发生面神经炎的患者为本研究对象,采用随机数字表法将其分为观察组和对照组各23例,对照组采用针灸拔罐联合甲钴胺穴位注射治疗,观察组在对照组基础上给予补阳还五汤治疗,比较2组患者治疗后近期、远期患部功...     

Monthly and seasonal variations in vestibular neuritis

Seasonal variations in vestibular neuritis (VN) could support the etiology of viral infection. However, several recent studies revealed no significant seasonal variations in VN. Further studies are necessary to determine the etiology of VN. We analyzed patients with VN to evaluate monthly and seasonal variations. Patients with VN who visited our otorhinolaryngology department or were referred to our department from the emergency department between March 2014 and February 2019 were included retrospectively in this study. Differences among the months and seasons of VN visits were analyzed. Patients were divided into 2 groups according to sex and age (65 years or older and younger than 65 years). Differences among the months and seasons of VN visits were analyzed between groups. There were no significant differences in monthly and seasonal distributions in 248 patients with VN. There were also no significant differences in monthly and seasonal distributions in male and female patients or in older and younger patients. There were no significant differences in monthly or seasonal distributions of patients with VN. Factors other than viruses, such as vascular ischemia, should also be considered in the incidence of VN, especially in older patients.     

鼠神经生长因子联合糖皮质激素治疗视神经炎的疗效观察

目的 观察鼠神经生长因子联合糖皮质激素治疗视神经炎的临床疗效.方法 收集临床确诊为视神经炎的48例患者48只眼.其中,视神经乳头炎8例8只眼,球后视神经炎40例40只眼.将患者随机分为治疗组和对照组.治疗组：22例22只眼,给予肌注鼠神经生长因子30 μg/次,1次/d,14天为1个疗程;全身静脉滴注地塞米松15mg/d,1周后改为强的松龙60 mg/d口服,每7天减量,每次减量10 mg,同时肌注维生素B1 100mg/d,维生素B120.5mg/d,连续14天,使用能量合剂、地巴唑10mg口服.对照组：26例26眼,除不使用鼠神经生长因子外,其余治疗同治疗组,对比分析两组患者治疗后的疗效.结果 治疗组22只眼中,显效18只眼,占81.8％;有效2只眼,占9.1％;无效2只眼,占9.1％,总有效率为90.9％;对照组26只眼中,显效14只眼,占53.8％;有效8只眼,占30.8％;无效4只眼,占15.4％;总有效率为84.6％.两组总有效率比较,差异无统计学意义（x2 =0.432,P=0.511＞0.05）;显效率比较,差异有统计学意义（x2 =4.196,P=0.041＜0.05）.结论 糖皮质激素能有效治疗视神经炎,联合鼠神经生长因子治疗有更好疗效.