Gabriel C M, Stevens J C, Bremner F, Brew S, Plant G T
Department of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
J Neurol Neurosurg Psychiatry. 2004 Sep;75(9):1343-5. doi: 10.1136/jnnp.2003.028662.
A patient with a history of pituitary tumour treated with yttrium 29 years before presented with an asymmetrical chiasmal neuropathy. Magnetic resonance imaging showed a partially thrombosed giant aneurysm of the right internal carotid artery, with enhancement of the chiasm and right optic tract adjacent to the aneurysm. It was thought that, in addition to the effects of compression, a peri-aneurysmal inflammatory reaction had developed, causing breakdown of the blood-brain barrier and consequent inflammatory changes in the optic chiasm. High dose steroid treatment led to significant improvement in vision within two weeks. Steroids may have a role in the acute preservation of vision in similar cases, as well as in cases of deterioration following coiling or embolisation of aneurysms where thrombosis within the aneurysm has been induced.
一名29年前曾接受钇治疗的垂体瘤患者出现不对称性视交叉神经病变。磁共振成像显示右侧颈内动脉有一个部分血栓形成的巨大动脉瘤，动脉瘤旁的视交叉和右侧视束有强化。据认为，除了压迫作用外，动脉瘤周围发生了炎症反应，导致血脑屏障破坏，进而引起视交叉的炎症改变。大剂量类固醇治疗在两周内使视力有显著改善。类固醇在类似病例的急性视力保护中可能起作用，在动脉瘤栓塞或盘绕后因诱导动脉瘤内血栓形成而导致视力恶化的病例中也可能起作用。
