Two patients of visual disturbance and optic perineuritis after placement of a flow diverter.

放置分流器后 ， 两名患者出现视力障碍和视神经膜炎。

• 发表时间: May 2022
• 来源期刊: Radiol Case Rep
• DOI: 10.1016/j.radcr.2022.01.085
• PMID: 35265246
• 文章类型: Case Reports
• 作者列表: Tanaka Y,Nagatsuka H,Miki Y,Tetsuo Y,Yabuzaki H,Nakayama S,Matsuda Y,Tsumoto T,Terada T,Tanaka Y,Nagatsuka H,Miki Y,Tetsuo Y,Yabuzaki H,Nakayama S,Matsuda Y,Tsumoto T,Terada T

关键词: Aneurysm; Complication; Flow diverter; Optic perineuritis; Visual disturbance; Aneurysm; Complication; Flow diverter; Optic perineuritis; Visual disturbance

Abstract

The pathogenesis of new visual symptoms after flow diverter stent placement in the ophthalmic artery for internal carotid artery aneurysms remains unclear. We report two cases of patients who developed visual field disturbance and decreased visual acuity following flow diverter placement. The \"doughnut sign\" was found around the optic nerve on magnetic resonance imaging. The patients had progressive visual field defects and impairment on the side where the flow diverter was placed. Short tau inversion recovery coronal images showed a doughnut-shaped high-signal around the optic nerve on the affected side. Both patients were treated with steroid pulse therapy, and 1 received endovascular therapy. Their symptoms gradually improved, and the \"doughnut sign\" disappeared. The \"doughnut sign\" observed around the optic nerve on magnetic resonance imaging may be found alongside visual disturbance symptoms after paraclinoid aneurysm treatment. It is recommended that short tau inversion recovery sequences be performed preoperatively in patients presenting with visual impairment and in whom the possibility of postoperative exacerbation is suspected.

摘要

在颈内动脉瘤的眼动脉中放置分流器支架后新的视觉症状的发病机制尚不清楚。我们报告了2例患者在放置分流器后出现视野障碍和视力下降。磁共振成像在视神经周围发现了“甜甜圈标志”。患者在放置分流器的一侧有进行性视野缺损和损伤。短tau反转恢复冠状图像显示患侧视神经周围的甜甜圈形高信号。两名患者均接受了类固醇脉冲治疗，1例接受血管内治疗。他们的症状逐渐好转,“甜甜圈标志”消失了。在磁共振成像上观察到的视神经周围的“甜甜圈标志”可以在手术后发现视觉障碍症状。建议对患有视力障碍且怀疑术后恶化的患者，术前进行短tau倒置恢复序列。