提示: 手机请竖屏浏览!

病例2-2018:一名出现视觉障碍和头痛的41岁女性
Case 02-2018 — A 41-Year-Old Woman with Vision Disturbances and Headache


Dean M. Cestari ... 其他 • 2018.01.18

陈述


John H. Stone医师:一名41岁女性因为头痛和6周的间歇性、短暂性视力丧失到本院风湿科门诊接受评估。

在此次就诊前4年,她右足出现皮疹,舌部也出现一个病变。在另一家医院进行两处病变的活检,结果显示白细胞碎屑性血管炎的迹象。使用泼尼松、氨甲蝶呤、吗替麦考酚酯和硫唑嘌呤后,皮肤黏膜病变改善,但尝试减少免疫抑制药剂量后再发。

在此次就诊前21个月,她出现头痛,且皮肤病变再发。头痛一般位于右颞部,表现为跳动,持续约5~10分钟。患者在另一家医院接受了评估,并进行对比增强的头部磁共振成像(MRI)。





作者信息

Dean M. Cestari, M.D., Mary E. Cunnane, M.D., Joseph F. Rizzo, III, M.D., and John H. Stone, M.D., M.P.H.
From the Departments of Ophthalmology (D.M.C., J.F.R.) and Radiology (M.E.C.), Massachusetts Eye and Ear, the Department of Medicine, Massachusetts General Hospital (J.H.S.), and the Departments of Ophthalmology (D.M.C., J.F.R.), Radiology (M.E.C.), and Medicine (J.H.S.), Harvard Medical School — all in Boston.

 

参考文献

1. ayreh MS, Hayreh SS. Optic disc edema in raised intracranial pressure. I. Evolution and resolution. Arch Ophthalmol 1977;95:1237-1244

2. Hayreh SS. Optic disc edema in raised intracranial pressure. V. Pathogenesis. Arch Ophthalmol 1977;95:1553-1565

3. Hayreh SS. Optic disc edema in raised intracranial pressure. VI. Associated visual disturbances and their pathogenesis. Arch Ophthalmol 1977;95:1566-1579

4. Binder DK, Horton JC, Lawton MT, McDermott MW. Idiopathic intracranial hypertension. Neurosurgery 2004;54:538-551

5. Sadun AA, Currie JN, Lessell S. Transient visual obscurations with elevated optic discs. Ann Neurol 1984;16:489-494

6. Hale N, Paauw DS. Diagnosis and treatment of headache in the ambulatory care setting: a review of classic presentations and new considerations in diagnosis and management. Med Clin North Am 2014;98:505-527

7. Sismanis A. Pulsatile tinnitus: a 15-year experience. Am J Otol 1998;19:472-477

8. Friedman DI, Jacobson DM. Diagnostic criteria for idiopathic intracranial hypertension. Neurology 2002;59:1492-1495

9. Friedman DI, Jacobson DM. Idiopathic intracranial hypertension. J Neuroophthalmol 2004;24:138-145

10. Dave S, Longmuir R, Shah VA, Wall M, Lee AG. Intracranial hypertension in systemic lupus erythematosus. Semin Ophthalmol 2008;23:127-133

11. Hershko AY, Berkun Y, Mevorach D, Rubinow A, Naparstek Y. Increased intracranial pressure related to systemic lupus erythematosus: a 26-year experience. Semin Arthritis Rheum 2008;38:110-115

12. Morris PP, Black DF, Port J, Campeau N. Transverse Sinus Stenosis Is the Most Sensitive MR Imaging Correlate of Idiopathic Intracranial Hypertension. AJNR Am J Neuroradiol 2017;38:471-477

服务条款 | 隐私政策 | 联系我们