Heran F, Schaison-Cusin M, Williams M, Piekarski J D
Service d'Imagerie, Fondation A. de Rothschild, 25 rue Manin, 75019 Paris, France.
J Neuroradiol. 2004 Sep;31(4):291-300. doi: 10.1016/s0150-9861(04)97008-3.
MRI often is mandatory in the diagnostic work-up of visual loss, visual field alterations and oculomotor problems. It is performed emergently in patients with painful diplopia associated to mydriasis, to exclude aneurysm, or in patients with painful Horner syndrome to exclude dissection of the internal carotid artery. CT scan in emergency remains useful in case of acute lateral hemianopsia or acute post traumatic visual loss. Progressive neuro-ophthalmological symptoms may require imaging examination in a short delay to define the therapeutic strategy: monocular transient blindness (dissection or carotid stenosis), progressive visual loss (optic nerve compression), bitemporal hemianopsia (optic chiasm lesion), painful visual loss (optic neuritis). A very precise clinical indication is helpful for the choice of imaging protocol and to improve its diagnosis value.
在对视力丧失、视野改变和动眼问题进行诊断检查时，MRI通常是必不可少的。对于伴有瞳孔散大的疼痛性复视患者，为排除动脉瘤需紧急进行MRI检查；对于疼痛性霍纳综合征患者，为排除颈内动脉夹层也需紧急进行MRI检查。对于急性外侧偏盲或急性创伤后视力丧失的情况，急诊CT扫描仍有帮助。进行性神经眼科症状可能需要在短时间内进行影像学检查以确定治疗策略：单眼短暂失明（夹层或颈动脉狭窄）、进行性视力丧失（视神经受压）、双颞侧偏盲（视交叉病变）、疼痛性视力丧失（视神经炎）。非常精确的临床指征有助于选择成像方案并提高其诊断价值。
