- 期刊
- OpenAccess
Papilledema Caused By Cryptococcal Meningitis in Two Immno-Competent Hosts
免疫健全成人隱球菌腦膜炎併發視神經盤水腫之二病例報告
摘要
本篇報告兩例免疫健全成人隱球菌腦膜炎併發視神經盤水腫。第一例是45歲健康男性有頭痛及頸部緊繃感兩個月，神經科檢查及電腦斷層掃瞄無異常，因最近一週眼睛感有飄浮物而至眼科就診。眼底發現視神經盤水腫，最佳矯正視力雙眼均壹點零。四天後出現複視，腦壓達430公厘水柱，腦脊髓液檢查證實隱球菌感染。經過一年治療，腦壓仍高，但視神經盤水腫消失，最佳矯正視力仍維持於壹點零。另一42歲女性因頭痛、頸部僵硬、發燒就醫，同時伴隨複視、視力模糊一個多月。眼底呈現視神經盤水腫，腦壓600公厘水柱，腦脊髓液檢查證實隱球菌感染。5個月治療後腦壓降至220公厘水柱，無視神經盤水腫，最佳矯正視力為零點三及零點九。隱球菌腦膜炎鮮少發生於免疫系統健全之成人，但是眼科醫師可能是第一個接觸病人的醫護人員，應有所警覺，以能早期發現及治療。
關鍵字
無資料並列摘要
Purpose: To describe two immuno-competent individuals with ocular manifestations of cryptococcal meningitis. Methods: Case report Results: One previous healthy 45-year-old male complained neck tightness and headache for two month. CT exam and neurological survey were noncontributory. One week later, floater developed in both eyes. The initial visual acuity was 6/6 (ou). Fundus showed papilledema. Visual field revealed blind spot enlargement (ou). Diplopia occurred 4 days later and bilateral abducens palsy was noted. Intracranial pressure (ICP) was 430 mmH2O and cerebrospinal fluid (CSF) analysis demonstrated cryptoccal infection. He then received amphotericin B and fluconazole therapy. ICP was fluctuated after one year treatment, but he remained good vision with minor residual visual field defect. The other 42-year-old female presented headache, neck stiffness, low grade fever, diplopia, and blurred vision for one more month. Best corrected VA was 6/10 (od) and 6/6 (os). Papilledema was found. CSF study showed an opening pressure 600 mm H2O with positive cryptococcal antigen. After treatment for 5 months, her papilledema was subsided. However, residual vision obscuration still persisted. Conclusion: Cryptococccal meningitis is rare for immuno-competent hosts. Since ophthalmologists are possible to first approach these patients, their quick response and immediate referral to neurologists can be great helpful in early diagnosis and treatment.
延伸閱讀
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