硬膜下血肿后出现的单侧视神经病变1例病案报道VIP免费

Unilateralopticneuropathyfollowingsubduralhematoma:acasereport硬膜下血肿后出现的单侧视神经病变：1例病案报道AlexandraKretz1,ChristophPreul1,Hans-JoergFricke2,OttoWWitte1andChristophTerborg31DepartmentofNeurology,UniversityofJenaMedicalSchool,ErlangerAllee101,JenaD-07747,Germany2DepartmentofInternalMedicine,Haemato-Oncology,UniversityofJenaMedicalSchool,ErlangerAllee101,JenaD-07747,Germany3DepartmentofNeurology,AsklepiosKlinikSt.Georg,LohmühlenStr.5,HamburgD-20099,GermanyauthoremailcorrespondingauthoremailJournalofMedicalCaseReports2010,4:19doi:10.1186/1752-1947-4-19Theelectronicversionofthisarticleisthecompleteoneandcanbefoundonlineat:http://www.jmedicalcasereports.com/content/4/1/19Received:12November2009Accepted:22January2010Published:22January2010©2010Kretzetal;licenseeBioMedCentralLtd.ThisisanOpenAccessarticledistributedunderthetermsoftheCreativeCommonsAttributionLicense(http://creativecommons.org/licenses/by/2.0),whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalworkisproperlycited.AbstractIntroductionUnilateralopticneuropathyiscommonlyduetoaprechiasmaticafflictionoftheanteriorvisualpathway,whilelossesinvisualhemifieldsresultfromthedamagetobrainhemispheres.Herewereporttheunusualcaseofapatientwhosufferedfromacuteopticneuropathyfollowinghemisphericalsubduralhematoma.Althoughconfirmeduptonowonlythroughnecropsystudies,ourcasestronglysuggestsalocal,microcirculatorydeficitidentifiedthroughmagneticresonanceimaginginvivo.CasepresentationA70-year-oldCaucasianGermanwhodevelopedamassivelefthemisphericsubduralhematomaunderoralanticoagulationpresentedwithacute,severevisualimpairmentonhislefteye,whichwasnoticedaftersurgicaldecompression.Neurologicandophthalmologicexaminationsindicatedsinistralopticneuropathywithvisualacuityreducednearlytoamaurosis.Ocularpathologysuchasvitreousbodyhemorrhage,papilledema,andcentralretinalarteryocclusionwereexcluded.Anorbitallesionwasruledoutbymeansoforbitalmagneticresonanceimaging.However,cerebraldiffusion-weightedimagingandT2mapsofmagneticresonanceimagingrevealedacircumscribedischemiclesionwithintheedematous,slightlyherniatedtemporomesiallobewithintheimmediatevicinityoftheaffectedopticnerve.Thus,theclinicalcourseandmorphologicmagneticresonanceimagingfindingssuggesttheoccurrenceofpressure-inducedposteriorischemicopticneuropathyduetomicrocirculatorycompromise.ConclusionAlthoughlesionsofthesecondcranialnervefollowingsubduralhematomahavebeenreportedindividually,theirpathogenesiswaspreferentiallyproposedfromautopsystudies.Herewediscussadual,pressure-inducedandsecondarilyischemicpathomechanismonthebaseofinvivomagneticresonanceimagingdiagnosticswhichmayremainunconsideredbycomputedtomography.IntroductionUnilateralopticneuropathy(ON)followingsubduralhematomahasbeenconfirmedbynecropsystudies.Inthesestudies,microcirculatorycompromiseoftheopticnervewasprovenasapathogenicmechanism[1].Inthiscasereport,diffusion-weightedimages(DWI)ofmagneticresonanceimaging(MRI)scansshowedsignalalterationintheipsilateralopticnerveasastrongevidenceforthedevelopmentofmicrovasculardeficit.Thus,ourcaseisinlinewithresultsfromautopsies.Tothebestofourknowledge,thisisthefirstcasepresentationthatdemonstratesmicrovascularimpairmentwithopticneuropathyinvivo.前言尸检研究已证实硬膜下血肿后可出现单侧视神经病变(opticneuropathy，ON)。这些研究证明视神经的微...