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病例37-2018:一名视力丧失的23岁女性
Case 36-2018 — A 23-Year-Old Woman with Vision Loss


Sashank Prasad ... 其他 • 2018.11.29

病历陈述


Seth N. Levin医师(神经科):一名有偏头痛病史的23岁右利手女性,因眩晕和右眼视力丧失在本院接受了评估。

入院前6日,患者出现右额头痛和右眼眶后疼痛;这些并不是患者既往偏头痛的典型表现。入院前5日,患者诉醒来时视力异常,据她描述为位于右眼鼻下象限视野内直径约6 cm的“灰点”(在12英寸距离处使用阿姆斯勒方格表[Amsler grid]测量)。当天晚些时候,患者右眼视力间歇性下降,她将其描述为“眼前发白”,每次持续45~60秒。患者难以确定异常的尺寸,但异常未累及右眼整个视野。患者眼球运动时无疼痛、无漂浮物、无闪光暗点。患者遮挡右眼时,左眼视力正常。

入院前3日出现过几次眩晕发作。患者将眩晕描述为“房间旋转”,持续约30秒。眩晕不是由有角度的头部运动引起。间歇性非体位性双额头痛每日发生1或2次,特别是当患者眼睛用力看手机或计算机时。患者无面部麻木,无眼球运动时视力丧失,也无其他神经症状。患者将异常描述为右眼鼻下象限视野内的一个灰点,灰点位置保持固定,在入院前的晚上,患者到本院附属的眼科医院就诊。





作者信息

Sashank Prasad, M.D., Lucy H. Young, M.D., Ph.D., Marc Bouffard, M.D., and Rajiv Gupta, M.D.
From the Departments of Neurology (S.P., M.B.), Ophthalmology (L.H.Y.), and Radiology (R.G.), Harvard Medical School, the Department of Neurology, Brigham and Women’s Hospital (S.P.), the Department of Ophthalmology, Massachusetts Eye and Ear (L.H.Y.), and the Departments of Neurology (M.B.) and Radiology (R.G.), Massachusetts General Hospital — all in Boston.

 

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