双眼红肿伴视力下降1例  

A case of bilateral eye redness and papilledema with decreased vision

作　　者：冯超逸 陈伟民 汤建军 陈倩 田国红 FENG Chaoyi;CHEN Weimin;TANG Jianjun;CHEN Qian;Tian Guohong(Department of Ophthalmology,Eye&ENT Hospital,Fudan University,Shanghai 200031,China;Department of Neurology,Shanghai Neuromedical Center,Shanghai 200040,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院眼科,上海200031 [2]上海德济医院神经内科,上海200040

出　　处：《中国眼耳鼻喉科杂志》2021年第S01期17-22,共6页Chinese Journal of Ophthalmology and Otorhinolaryngology

摘　　要：67岁男性,因双眼红肿伴右眼视力下降3个月来诊。曾因喉咽癌行全喉切除+双侧颈淋巴结清扫术(包括双侧颈内静脉)。检查发现双眼结膜、巩膜血管迂曲扩张,左眼眼压升高,双眼视乳头高度水肿伴右眼盘周出血。左眼扩张的眼上静脉内彩超探及逆向的动脉化血流。磁共振成像(MRI)提示空蝶鞍,排除肿瘤转移。脑脊液压力>330 mmH2O。经磁共振血管成像(MRA)和数字减影血管成像(DSA)最终诊断:右侧乙状窦硬脑膜动静脉瘘;颅高压。手术栓塞动静脉瘘后,患者的颅压恢复正常,视乳头水肿有所消退。A 67-year-old man complained of bilateral eye redness and decreased vision in his right eye for 3 months.He had undergone total laryngectomy+bilateral neck dissection(including bilateral internal jugular veins)for laryngeal cancer.Ophthalmologic examination revealed bilateral dilated conjunctival veins with increased intraocular pressure in the left eye,the fundus showed severe bilateral papilledema and peripapillary hemorrhage in the right eye.Reverse arterialized blood flow was discovered in the left superior ophthalmic vein by color Doppler ultrasound.MRI revealed Empty Sella and no metastasis of carcinoma.Cerebrospinal pressure was above 330 mmH2O.He was finally diagnosed with a right sigmoid sinus dural arteriovenous fistula and intracranial hypertension based on magnetic resonance angiography(MRA)and digital subtraction angiography(DSA).Embolization surgery resulted in relief of papilledema and normal intracranial pressure.

关 键 词：视乳头水肿 海绵窦动静脉瘘 脑动静脉畸形颅高压 

分 类 号：R651.12[医药卫生—外科学]