Pseudotumor Cerebri in a Renal Transplant Recipient: A Case Report

腎臟移植患者產生之偽腦瘤症－病例報告

張璟育(Ching-Yu Chang) ； 陳烜(Shuan Chen) ； 高啓祥(Shine C. S. Kao)

《中華民國眼科醫學會雜誌》 43卷3期 (2004/09) Pp. 192-197

https://doi.org/10.30048/ACTASOS.200409.0008

摘要

目的：報告一腎臟移植患者產生之偽腦瘤症
方法：病例報告
結果：46歲男性腎臟移植患者，因間歇性暫時視力模糊而來求診，經檢查發現有雙眼視乳突水腫，視野缺損及色感缺失之症狀，電腦斷層未見腫瘤，經脊椎穿刺發現顱內壓升高而腦脊液成份正常，核磁共振靜脈攝影可見疑似上矢狀竇末端栓塞，經治療患者顱內壓於3個月後回復正常，除了1次右腿深部靜脈栓塞之外，患者狀況維持穩定，在7個月後視乳突水腫回復正常，視野缺損及色感缺失亦改善
結論：因腎臟移植本身或使用免疫抑制藥物(Tacrolimus, Cyclosporin)所引起之血栓傾向可能導致偽腦瘤症，腎臟移植患者可能產生頭痛，視覺不良或視乳突水腫之症狀，儘速診斷並處理此一罕見且嚴重但可治療之病症有賴於眼科醫師之警覺性

並列摘要

Purpose: We reported a renal transplant recipient who developed pseudotumor cerebri (PTC) in the course of his follow-up.
Method: Case report.
Result: A 46-year-old male renal transplant recipient visited our clinic with the chief complaint of transient blurred vision intermittently on both eyes for 2 weeks. He underwent a smooth renal transplantation 8 months ago, and he had no hypertension or diabetic history. Our ophthalmologic examination showed that he had bilateral severe papilledema (grade Ⅳ), visual field defect, and color sense disturbance. He had good visual acuity and no other ocular abnormality. His orbital computed tomography (CT) showed the typical target sign and the rail tract sign on both optic nerves, but there was no mass lesion. The lumbar puncture performed by the neurologists showed the high initial intracranial pressure (ICP) (300 mmH2O) and the normal cerebrospinal fluid (CSF) content. The magnetic resonance venography (MRV) study for the head strongly suggested the superior saggital sinus (SSS) thrombosis at the distal end. Therefore, the neurologist started the treatment of Diamox, Coumadin and multiple lumbar punctures. Besides, due to the adverse effect of Tacrolimus was also suspected in the pathogenesis of the patient's PTC, Cyclosporine was given in substitute of his immunosuppressive therapy by the nephrologist. The patient's ICP returned to normal level after these treatments about 2 months later. Afterwards, this patient only suffered from a minor attack of right leg deep vein thrombosis and remained stable since then. 7 months later, the papilledema of optic discs was completely resolved as well as the visual field defect and the color sense disturbance.
Conclusion: The thrombotic tendency occurred following renal transplanttation or the use of Tacrolimus or Cyclosporin for immunosuppressive treatment may lead to PTC. Patients with renal transplant might develop rare eye conditions such as headache, visual disturbance or papilledema. Prompt diagnosis and management of this rare and serious but treatable condition depends on the ophthalmologist's alertness.

並列關鍵字

Pseudotumor cerebri ； Renal transplant recipient ； Papilledema