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Optic Neuropathy in a Case of Orbital Lymphoma
眼窩內惡性淋巴瘤併發視神經病變的一例病歷報告
摘要
本文報導一位四十歲女病人，曾經在四年前接受腎臟移植，並有長期的慢性蓄膿鼻竇炎，左眼突然在一週內發生無痛性視神經炎以及左眼眼球運動障礙。電腦斷層掃瞄發現在病人左眼眼窩的內壁有腫瘤，壓迫左眼內直肌並伴隨視神經腫大。病人在接受腫瘤摘除，大量類固醇和廣效性抗生素的治療下，眼球運動獲得改善，但視力卻繼續惡化到完全沒有光覺；此時，flash VEP也完全消失。病人檢體的培養並沒有長出任何細菌或黴菌，然而病理組織切片證實為惡性淋巴瘤。病人在完全失明七天後，開始接受化學治療。治療三天後，視力開始慢慢恢復；二個月後，復原到1.0，但是視野仍有缺損，而且病人的pattern VEP有很明顯的延長。觀察了病人的全程經過以及一系列的電氣生理學檢查，我們推測本病人的視神經病變；乃是惡性淋巴瘤直接侵入視神經所致，但是由於化學治療沒有及時開始，病人的視神經功能無法完全恢復正常。
關鍵字
無資料並列摘要
A case is presented in which a 40-year-old patient with a previous history of renal transplant and chronic necrotizing sinusitis, developed rapidly painless deteriorating vision, hyperemic optic disc and limitation of ocular movements in the left eye within one week. CT scan revealed a medial retroorbital mass compressing the medial rectus, and mild enlargement of the left optic nerve. After orbitotomy, her ocular movements improved, however, the optic neuropathy became worse to no light perception. The flash VEP was severely disrupted. The culture for bacteria and fungus was negative. The pathology showed malignant lymphoma. She remained completely blind for 7 days despite large dose of steroid treatment. She was then given chemotherapy. Her vision started to improve after 3 days of chemotherapy. Both VA and VF were improved gradually. The final VA was 1.0 with a significantly delayed pattern VEP two months after visual loss. In this case, we concluded that the optic neuropathy was due to tumor infiltration, however, the delay of starting chemotherapy might cause an incomplete recovery of optic neuropathy.
延伸閱讀
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