单侧枕叶梗死眼部表现的临床分析

目的:探讨单侧枕叶梗死引起的眼部表现的临床特点及发生机制。方法:回顾性分析18例单侧枕叶梗死患者的临床资料及眼部表现,且所有患者的梗死灶均局限于枕叶。结果:患者18例中出现眼部症状者16例(89%),包括双眼视力下降15例(83%)、视幻觉5例(28%)。其中,8例发病时仅有眼部症状。所有患者均有视野改变,包括完全性同向偏盲12例(67%)和部分性同向偏盲5例(28%)。12例完全性同向偏盲患者中,黄斑回避7例(58%),黄斑分裂5例(42%)。接受随访者12例,随访时间为6～29mo不等,出现视神经萎缩4例、视力增进1～2行者5例、视野扩大2例、视力下降1例、黄斑回避转变为黄斑分裂1例。结论:单侧枕叶梗死的临床特征以眼部表现为主,包括双眼视力下降、视幻视、伴或不伴有黄斑回避的一致性同向偏盲、无瞳孔和眼底改变。随访中发现,枕叶梗死引起的视力下降、视野缺损一般不易恢复,少数患者可出现视神经萎缩。

Clinical analysis of ocular manifestations in patients with unilateraloccipital infarction

AIM:To investigate the clinical characteristics and mechanisms of ocular manifestations in patients with unilateraloccipital infarction.·METHODS:The clinical data and ocular manifestations in 18 patients with unilateraloccipital infarction were analyzed retrospectively.Their infarction area was confined to the occipital lobe in all patients.·RESULTS:In the 18 patients,eye symptoms were found in 16 cases(89%),including biocular visual acuity decrease(15 cases,83%) and optical illusion(5 cases,28%).8 patients had only eye symptoms at the time of seizure disorders.The defect of visual field was detected in all patients,including completely homonymous hemianopsia(12 cases,67%) and partly homonymous hemianopsia(5 cases,28%).There were macular sparing(7 cases,58%) and macular splitting(5 cases,42%) in 12 cases with completely homonymous hemianopsia.Follow-up was accomplished in 12 patients,and the follow-up period ranged from 6 months to 29 months.There were optic atrophy(4 cases),augment of visual acuity with 1-2 lines(5 cases),dilatation of visual field(2 cases),decrease of visual acuity(1 cases) and the transition from macular sparing to macular splitting(1 cases).·CONCLUSION:Ocular manifestations,including biocular visual acuity decrease,optical illusion,consistency-homonymous hemianopsia with or without macular sparing and no changes of pupilla and ocular fundus,were the major clinical features of unilateraloccipital infarction.It is uneasy to recover the changes of visual acuity and visual field caused by occipital infarction,which was found duing the follow-up period.Moreover,optic atrophy may be found in a few patients.