Looking beyond blurred margins

IF 5.1 2区 医学 Q1 OPHTHALMOLOGY
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引用次数: 0

Abstract

A 60-year-old man presented to an outside ophthalmology clinic with 1 month of progressive vision loss in the right eye (OD). Right optic disc edema was noted. Brain and orbit magnetic resonance imaging revealed right optic nerve and left occipital lobe enhancement. He was seen initially by neurology and neurosurgery and subsequently referred to neuro-ophthalmology for consideration of optic nerve biopsy. He was seen 3 months after his initial symptom onset where vision was light perception OD and a relative afferent pupillary defect with optic nerve edema. OS was unremarkable. A lumbar puncture with flow cytometry was negative for multiple sclerosis and lymphoma. At his oculoplastic evaluation for optic nerve biopsy, his vision was noted to be no light perception OD. Optic nerve biopsy demonstrated non-caseating granulomatous inflammation consistent with neurosarcoidosis. The patient was started on high-dose oral steroids with improvement of disc edema, as well as significant improvement in optic nerve and intracranial parenchymal enhancement, although his vision never improved.

临床挑战:超越模糊边缘。
一名 60 岁的男子因右眼(OD)视力逐渐下降 1 个月而到外院眼科就诊。发现右侧视盘水肿。脑部和眼眶磁共振成像显示右侧视神经和左侧枕叶增强。他最初在神经内科和神经外科就诊,随后被转到神经眼科考虑进行视神经活检。他在最初症状出现 3 个月后就诊,视力为光感 OD,瞳孔相对传入缺损,视神经水肿。视网膜检查无异常。腰椎穿刺流式细胞术检查结果为多发性硬化和淋巴瘤阴性。在对他进行视神经活检的眼部整形评估时,发现他的视力没有光感。视神经活检显示为非酪氨酸肉芽肿性炎症。患者开始口服大剂量类固醇,视盘水肿有所改善,视神经和颅内实质增强也有明显改善,但视力一直没有改善。
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来源期刊
Survey of ophthalmology
Survey of ophthalmology 医学-眼科学
CiteScore
10.30
自引率
2.00%
发文量
138
审稿时长
14.8 weeks
期刊介绍: Survey of Ophthalmology is a clinically oriented review journal designed to keep ophthalmologists up to date. Comprehensive major review articles, written by experts and stringently refereed, integrate the literature on subjects selected for their clinical importance. Survey also includes feature articles, section reviews, book reviews, and abstracts.
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