首诊眼科的颅内病变患者临床分析

目的:分析首诊于眼科的颅内病变患者临床特征。方法:回顾性分析2009年6月至2012年4月因视力障碍或视野缺损首诊于我院眼科的13例患者,均以视神经病变、视乳头水肿收入院,最终经MRI、MRV、脑脊液检查等确诊为颅内病变。结果:13例患者单眼发病5例,双眼发病8例,11例以视力下降或一过性视物模糊为主要症状,2例以视野缺损为主要症状,行头颅MRI检查7例为颅内占位性病变,具体为:3例脑膜瘤,1例松果体瘤,1例颅咽管瘤,2例颈内动脉瘤,余6例头颅CT或MRI检查未见明显异常,腰穿脑脊液压力均大于250mmH2O,其中2例MRV或DSA检查提示颅内静脉窦血栓形成(CVST)。结论:以视神经病变、视乳头水肿为表现的患者应行头颅MRI检查以排除颅内占位性病变,有些视乳头水肿患者头颅MRI检查阴性时,需进一步行MRV、DSA等检查以排除颅内静脉窦血栓形成等疾病。

Clinical Analysis of Patients with Intracranial Lesions Consulting the Ophthalmologist First

Objective: To analyze the clinical characteristics of patients with intracranial lesions consulting the ophthalmologist first.Methods: A retrospective analysis was conducted in 13 patients with visual impairment or visual field defect came to the ophthalmology department first from June 2009 to April 2012.They were diagnosed as optic neuropathy or papilledema,eventually confirmed as intracranial lesions by MRI,MRV,and cerebrospinal fluid examination.Results: Of the 13 patients,5 cases were unilateral,8 cases were bilateral,11 patients showed decreased vision or transient blurred vision,and 2 patients had visual field defects.Seven patients were confirmed as intracranial space-occupying lesions by cranial MRI examination,which included 3 cases of meningioma,1 case of pinealoma,1 case of craniopharyngioma,and 2 cases of internal carotid aneurysm.Another 6 cases showed normal in MRI,but with elevated opening cerebrospinal fluid(CSF) pressure of more than 250 mmH2O on lumbar puncture.Two cases of them were revealed as cerebral venous sinus thrombosis by MRV or DSA.Conclusion: It was necessary for the patients of optic neuropathy or papilledema to exclude intracranial space-occupying lesions by MRI examination.For some patients of papilledema with MRI negative,further examinations such as MRV,DSA and so on,were necessary to exclude cerebral venous sinus thrombosis and other diseases.