Katz B
Pacific Presbyterian Medical Center, San Francisco, California.
Surv Ophthalmol. 1991 Sep-Oct;36(2):133-9. doi: 10.1016/0039-6257(91)90126-z.
A 56-year-old woman presented with a four-month history of transient obscurations of vision that progressed to constant visual loss. She had a nodular, lumpy-bumpy, cauliflower-like asymmetric edema of the nerve head, which suggested direct optic nerve head invasion with foreign tissue. Imaging of her intracranial contents revealed a well circumscribed gadolinium enhancing mass in the middle fossa. Histopathology of material obtained at craniotomy revealed noncaseating granulomata consistent with sarcoidosis. Central nervous system sarcoid may present either as an infiltrative granulomatous process, or one of discrete tumor mass, masquerading as a neoplasm. Neurologic symptoms and signs often herald the presence of systemic disease. Our illustrates that isolated sarcoid optic neuropathy may occur and be associated with neither intraocular inflammatory signs nor extensive disease elsewhere; indeed, it may be the first declaration of neurosarcoidosis.
一名56岁女性，有4个月的短暂视力模糊病史，之后发展为持续性视力丧失。她的视乳头有结节状、凹凸不平、菜花状不对称水肿，提示有异物组织直接侵犯视乳头。其颅内内容物成像显示中颅窝有一个边界清晰的钆增强肿块。开颅手术获取材料的组织病理学检查显示为符合结节病的非干酪样肉芽肿。中枢神经系统结节病可表现为浸润性肉芽肿过程，或表现为离散肿瘤样肿块，伪装成肿瘤。神经症状和体征常常预示着全身性疾病的存在。我们的病例表明，孤立性结节病性视神经病变可能发生，且既不伴有眼内炎症体征，也无其他部位的广泛病变；事实上，它可能是神经结节病的首发表现。
