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。

Clinical Analysis of Six Optic Neuritis Due to Multiple Sclerosis

Objective:To analyze the cases of optic neuritis and their connection with multiple sclerosis(MS).Methods:We followed in a retrospective(2003~2006) study 6 patients with optic neuritis which were verified MS at last.Results:51 cases of optic neuritis in our Hospital at the same period,six cases were final verified MS.Six cases of age of onset is 16 to 62 years old.3 cases of monocular disease,three cases of bilateral.In 4 cases there was pain in the region of the eye.Before the treatment,Visual acuity were no light perception to 0.8.Three optic disk were found swelling,two optic disk were normal,one optic disk were white.Three previous attacks eyes have shown the pale disk.One patient was lack of systemic symptoms and diagnosed by intracranial magnetic resonance image(MRI).The other five cases appeared weakness of legs,and four cases of spinal MRI examination found lesions.The last one case were diagnosed on the history.Conclusion:MS is a most common cause of optic neuritis,accounting for about 11.8% of optic neuritis.In China,most of patients were spinal cord damage.age of onset,damage of visual acuity,optic disk were influenced or not,and pain were not help to judge optic neuritis will eventually developed into the MS.