三叉神经鞘瘤并发神经麻痹性角膜炎一例  

Trigeminal schwannoma complicated with nerve paralysis keratitis:a case report

作　　者：彭烨 王瑞栋[2] 王春芳[2] PENG Ye;WANG Ruidong;WANG Chunfang(Shanxi Medical university,Taiyuan 030000,China;First Hospital of Shanxi Medical University,Taiyuan 030000,China)

机构地区：[1]山西医科大学,太原030000 [2]山西医科大学第一医院,太原030000

出　　处：《眼科学报》2023年第4期360-363,共4页Eye Science

摘　　要：该文报道一例中年男性患者,因“头痛伴左侧听力下降”就诊于我院神经外科,经影像学检查诊断为“左侧三叉神经鞘瘤”,手术前实验室检查发现血象异常,经血液科会诊后诊断为多发性骨髓瘤Ig Dλ型,于化疗期间并发神经麻痹性角膜炎(neurotrophic keratitis,NK),可于角膜中央偏下方的上皮及前基质层见到类圆形的灰白色浑浊,呈胶冻样,经局部药物治疗后好转,但残留角膜基质白色浑浊。由于现阶段临床对NK尚欠缺充分认识,易延误诊治,并且本文报道的此例NK患者,因其有化疗病史且于治疗期间出现相关体征,易被误诊为化疗并发细菌性角膜炎,文章通过分析其角膜病变的特征及简单回顾NK的临床特征、鉴别诊断及治疗,以期临床早期识别及治疗此类患者,恢复角膜的光学特性,维持良好的视觉体验。This article reports a case of a middle-aged male patient who visited the Department of Neurosurgery of our hospital due to headache and left hearing loss.He was diagnosed with left trigeminal schwannoma by imaging examination and abnormal blood routine before surgery.During chemotherapy and paralytic keratitis(neurotrophic keratitis,NK),can be seen in the lower part of the corneal center of the epithelium and the prestromal layer of round gray and white turbidities,jelly like,after local drug treatment improved,but residual corneal stromal white turbidities.Due to the lack of full understanding of NK in clinic at the present stage,diagnosis and treatment is easy to be delayed.In addition,the NK patient reported in this paper was easily misdiagnosed as bacterial keratitis complicated by chemotherapy due to his history of chemotherapy and related signs during treatment.This paper analyzed the characteristics of keratopathy and briefly reviewed the clinical characteristics,differential diagnosis and treatment of NK,in order to identify and treat these patients in early clinical stage,restore the optical characteristics of cornea and maintain good visual experience.

关 键 词：神经麻痹性角膜炎 三叉神经鞘瘤 鉴别诊断 

分 类 号：R739.43[医药卫生—肿瘤] R772.21[医药卫生—临床医学]