Hirayama Takehisa, Ikeda Ken, Hidaka Takanobu, Nagata Riya, Yoshii Yasuhiro, Kawabe Kiyokazu, Iwasaki Yasuo
Department of Neurology, Toho University Omori Medical Center, Tokyo, Japan.
Case Rep Neurol. 2010 Nov 3;2(3):128-132. doi: 10.1159/000322143.
Optic neuritis (ON) is a rare neurological complication of measles infection. Little is known about measles-associated retrobulbar ON. Here, we report a distinct patient with unilateral retrobulbar ON due to measles infection. A 26-year-old woman developed maculopapular rash and Koplik spots. On the following 3 days, she noticed blurred vision in the left eye. A Goldmann visual field test showed inferior nasal quadrantanopsia in the left eye. Visual acuity was 20/20 in OD and 20/100 in OS. Pupillary size was 2.0 mm in the right eye and 4.0 mm in the left eye. Light reflexes were slightly sluggish in the left eye. Ophthalmoscopy showed mild pallor of the left optic disc. Central critical flicker fusion frequency (CFF) was 40.7 Hz in the right eye and 10.1 Hz in the left eye (normal =29.0). Visual evoked potentials showed that P100 latencies were delayed on the left side (133 ms). Brain and spinal cord MRI was normal. Orbital MRI displayed abnormal enhancement in the left optic nerve. Serum and cerebrospinal fluid IgG titers of anti-measles antibodies were increased. Left measles-associated ON was diagnosed. Methylprednisolone pulse therapy followed by oral administration of prednisolone ameliorated visual acuity, visual field and CFF. The neuroophthalmic profile of our patient indicated that measles infection triggered isolated retrobulbar ON, leading to unusual visual deficits. Thus, physicians should pay more attention to variable patterns of measles-associated ON.
视神经炎（ON）是麻疹感染罕见的神经系统并发症。关于麻疹相关性球后视神经炎，人们了解甚少。在此，我们报告一名因麻疹感染导致单侧球后视神经炎的独特患者。一名26岁女性出现斑丘疹和科氏斑。在接下来的3天里，她注意到左眼视力模糊。戈德曼视野检查显示左眼鼻下象限视野缺损。右眼视力为20/20，左眼视力为20/100。右眼瞳孔大小为2.0毫米，左眼为4.0毫米。左眼光反射稍迟钝。眼底检查显示左眼视盘轻度苍白。右眼中央临界闪烁融合频率（CFF）为40.7赫兹，左眼为10.1赫兹（正常=29.0）。视觉诱发电位显示左侧P100潜伏期延迟（133毫秒）。脑和脊髓MRI正常。眼眶MRI显示左侧视神经异常强化。血清和脑脊液抗麻疹抗体IgG滴度升高。诊断为左侧麻疹相关性视神经炎。甲泼尼龙冲击治疗后口服泼尼松改善了视力、视野和CFF。我们患者的神经眼科表现表明，麻疹感染引发了孤立的球后视神经炎，导致了异常的视觉缺陷。因此，医生应更加关注麻疹相关性视神经炎的不同表现形式。
