PDF(Pubmed)
Abstract：
A 60-year-old white woman presented to the emergency department with painless decrease of visual acuity in the left eye (LE). The diagnosis of a non-arteritic anterior ischemic optic neuropathy in the LE was established based on the clinical picture and the results of static perimetry, fluorescein angiography, visual evoked potential, and magnetic resonance imaging (MRI) of the brain and orbit. Six months later, the patient reported visual impairment in the right eye (RE). Best corrected visual acuity (BCVA) in the RE was 5/10. Gadolinium-enhanced MRI showing inflammation of both optic nerves and the optic chiasm in correlation with positivity for immunglobulin G antibody against aquaporin-4 led to the diagnosis of late-onset neuromyelitis optica spectrum disorder. High-dose intravenous methylprednisolone therapy followed by oral tapering was administered and oral azathioprine was started to reduce the risk of further relapse. At discharge, BCVA was 5/5 in the RE. The patient remains under the care of neurology and ophthalmology clinics, with no recurrences for two years. The possibility of neuromyelitis optica spectrum disorder with optic neuritis in older patients is important in the differential diagnosis of ischemic optic neuropathy.
摘要：
一名60岁的白人妇女出现在急诊科，左眼（LE）视力无痛下降。根据临床表现和静态视野检查的结果，确定了LE非动脉炎性前部缺血性视神经病变的诊断。荧光素血管造影,视觉诱发电位,以及大脑和眼眶的磁共振成像（MRI）。六个月后,患者报告右眼视力障碍(RE).RE中最好矫正视力(BCVA)为5/10。钆增强的MRI显示视神经和视交叉的炎症与针对水通道蛋白4的免疫球蛋白G抗体阳性相关，可诊断为迟发性视神经脊髓炎谱系障碍。大剂量静脉注射甲基强的松龙治疗，然后口服逐渐减少，并开始口服硫唑嘌呤以降低进一步复发的风险。出院时,BCVA在RE中是5/5。病人仍在神经科和眼科诊所的照顾下,两年没有复发.老年患者视神经脊髓炎谱系障碍伴视神经炎的可能性在缺血性视神经病变的鉴别诊断中很重要。
