伴眼部症状的颅内静脉窦血栓形成眼科漏诊、误诊临床分析  

Clinical investigation of missed diagnosis and misdiagnosis of cranial venous sinus thrombosis companied with ocular symptoms

作　　者：李晓明[1] 魏世辉[2] 宋鄂[1] 

机构地区：[1]吉林大学第一医院眼科,吉林省长春市130021 [2]解放军总医院眼科,北京市100853

出　　处：《眼科新进展》2010年第2期137-140,共4页Recent Advances in Ophthalmology

基　　金：吴阶平医学基金资助(编号:320-3700-06002)~~

摘　　要：目的分析伴眼部症状的颅内静脉窦血栓形成(cranial venous sinus thrombosis,CVST)眼科漏诊、误诊情况,眼科临床特点及CVST确诊方法。方法回顾性分析19例伴眼部症状的眼科漏诊、误诊CVST患者的眼科临床特点及影像学检查结果。结果19例伴眼部表现的CVST患者均伴双侧视盘水肿。所有患者均伴有颅内压增高,13例高于300mmH2O,双眼视力下降18例,双眼复视7例,一过性黑矇1例。其中,10例误诊为双眼视盘炎,5例误诊为双侧视盘血管炎,误诊为前部缺血性视神经病变、Vogt-小柳原田综合征伴外展神经麻痹、Leber遗传性视神经病变、双侧外展神经麻痹各1例。19例患者中,经数字减影血管造影确诊12例,经磁共振(magnetic resonance imaging,MRI)+磁共振血管成像确诊6例,经MRI确诊1例。结论伴视力下降、复视、视盘水肿等眼部表现的CVST易被漏诊或误诊为其他眼科疾病。MRI+磁共振血管成像可做为确诊CVST首选检查方法,数字减影血管造影确诊CVST更为准确。眼科医师遇到伴双侧视盘水肿的患者应考虑到CVST的可能。Objective To investigate ocular clinical characteristics and diagnosis of cranial venous sinus thrombosis （CVST）,missed diagnosis and misdiagnosis of CVST companied with ocular symptoms.Methods Ocular clinical characteristics and iconography examination results were retrospectively analyzed in 19 CVST cases companied with ocular symptoms,who were with missed diagnosis or misdiagnosis.Results Nineteen CVST cases companied with ocular symptoms were found with optic disc edema.Intracranial pressure was increased in all cases and more than 300 mmH2O in 13 cases.Binocular visual acuity of 18 cases were decreased.Seven cases were companied with binocular diplopia.One case was with amaurosis fugax.Ten cases were misdiagnosed with bilateral neuropapillitis,5 cases with bilateral papillovasculitis,and ischemic optic neuropathy,Vogt-Koyanagi-Harada syndrome companied with oculomotor nerve palsy,Leber＇s optic neuropathy and abducens nerve palsy were made misdiagnosis in 1 case each.Among all cases,12 cases were finally made diagnosis with CVST by digital subtraction angiography,6 cases by magnetic resonance imaging combined with magnetic resonance angiography and 1 case by magnetic resonance imaging.Conclusions Patients with CVST are often companied with slight decline of visual acuity,diplopia and optic disc edema.CVST is easy to be made misdiagnosis or missed diagnosis.Magnetic resonance imaging combined with magnetic resonance angiography can be the first choice to make diagnosis of CVST,and digital subtraction angiography is the most accurate method to make diagnosis of CVST.Ophthalmologists should consider the possibility of CVST when examing patients with bilateral optic disc edema.

关 键 词：颅内静脉窦血栓形成 视盘水肿 数字减影血管造影技术 磁共振 磁共振血管成像 

分 类 号：R774.6[医药卫生—眼科]