Hasumi Yukiko, Ishihara Mami, Asukata Yuri, Nishida Tomomi, Hayashi Kiyofumi, Nakamura Satoshi, Mizuki Nobuhisa
Department of Ophthalmology and Visual Sciences, Yokohama City University Graduate School of Medicine, Japan.
Nippon Ganka Gakkai Zasshi. 2007 Sep;111(9):728-34.
To report a case of neurosarcoidosis with rapid progression of visual field defects.
A 28-year-old woman presented with bilateral uveitis and was diagnosed as having sarcoidosis after skin and cervical lymph node biopsy. Since bilateral excavations of the optic nerve head and visual field defects were observed, endocranial lesion was suspected. However, a computed tomography (CT) scan of the head detected nothing abnormal. It was regarded as a case of sarcoidosisaccompanied by normal-tension glaucoma and treatment was initiated with latanoprost. Four months later, the patient's visual field deteriorated rapidly. A CT scan showed a pituitary mass. Neurologicalfindings and hypopituitarism were found which improved with systemic prednisolone therapy. Diabetes insipidus developed after the start of treatment, and was treated with intranasal desmopressin therapy. After 6 weeks, head magnetic resonance imaging (MRI) showed a remarkable reduction of the enhanced regions.
Although ocular sarcoidosis is often accompanied by secondary glaucoma or optic nerve atrophy, the progression of neurosarcoidosis can lead to visual field defects. Central nervous system (CNS) sarcoidosis is rare, but a precise examination with enhanced MRI should be considered when the visual field defect progresses rapidly.
报告一例视野缺损迅速进展的神经结节病病例。
一名28岁女性因双侧葡萄膜炎就诊，经皮肤及颈部淋巴结活检后被诊断为结节病。由于观察到双侧视神经乳头凹陷及视野缺损，怀疑存在颅内病变。然而，头部计算机断层扫描（CT）未发现异常。该病例被视为结节病合并正常眼压性青光眼，并开始使用拉坦前列素进行治疗。四个月后，患者视野迅速恶化。CT扫描显示垂体肿块。发现神经学表现及垂体功能减退，全身使用泼尼松龙治疗后症状改善。治疗开始后出现尿崩症，采用鼻腔内去氨加压素治疗。6周后，头部磁共振成像（MRI）显示强化区域明显缩小。
尽管眼部结节病常伴有继发性青光眼或视神经萎缩，但神经结节病的进展可导致视野缺损。中枢神经系统（CNS）结节病较为罕见，但当视野缺损迅速进展时，应考虑进行增强MRI的精确检查。
