Chai Yuzhu, Yamazaki Hiroko, Kondo Akihide, Oshitari Toshiyuki, Yamamoto Shuichi
Department of Ophthalmology, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba.
Clin Ophthalmol. 2012;6:661-6. doi: 10.2147/OPTH.S30418. Epub 2012 May 7.
We present detailed ophthalmic findings in a case of tuberculum sellae meningioma with acute visual symptoms due to optic canal involvement. A 62-year-old Japanese woman reported a 1-week history of headaches and blurred vision in her left eye. Her visual acuity was 0.3 in the left eye with no ophthalmoscopic abnormalities. A relative afferent pupillary defect and inferior temporal field defect were found in the left eye. Pattern visual evoked potentials were undetectable in the left eye. Enhanced magnetic resonance imaging showed a 9 mm intracranial lesion around the left optic nerve anterior to the chiasm. She was diagnosed with granulomatous inflammation because of the increased cell counts and protein concentration in the cerebrospinal fluid. She was treated with steroid pulse therapy, and her visual acuity and visual field defect improved to normal in 3 weeks. However, 16 months after the onset, she suffered from headaches again and had a complete loss of vision in her left eye. There was no response to steroid pulse therapy. Enhanced magnetic resonance imaging revealed that the lesion had extended into the left optic canal, and emergency tumor removal surgery was carried out. The histopathological diagnosis was meningioma. One month after the surgery, her left visual acuity improved to 1.2, and her visual field was almost normal. Pattern visual evoked potentials were present but had a prolonged P(100) latency of 170 ms. A thinning of the ganglion cell complex was detected by optical coherence tomography. Ophthalmologists should be aware that a small tuberculum sellae meningioma can cause acute visual symptoms due to optic canal involvement. Early consultation with a neurosurgeon is necessary. Visual evoked potentials and optical coherence tomography are sensitive and helpful in following patients with optic nerve compression.
我们报告了一例因视神经管受累而出现急性视觉症状的蝶骨嵴脑膜瘤患者的详细眼科检查结果。一名62岁的日本女性报告称，她有1周的头痛和左眼视力模糊病史。她的左眼视力为0.3，眼底镜检查未见异常。左眼发现相对传入性瞳孔障碍和颞下象限视野缺损。左眼无法检测到图形视觉诱发电位。增强磁共振成像显示，在视交叉前方的左侧视神经周围有一个9毫米的颅内病变。由于脑脊液中细胞计数和蛋白质浓度增加，她被诊断为肉芽肿性炎症。她接受了类固醇脉冲疗法治疗，3周后视力和视野缺损恢复正常。然而，发病16个月后，她再次出现头痛，左眼完全失明。类固醇脉冲疗法对此无效。增强磁共振成像显示病变已扩展至左侧视神经管，遂进行了急诊肿瘤切除手术。组织病理学诊断为脑膜瘤。手术后1个月，她的左眼视力提高到1.2，视野几乎正常。图形视觉诱发电位存在，但P(100)潜伏期延长至170毫秒。光学相干断层扫描检测到神经节细胞复合体变薄。眼科医生应意识到，小的蝶骨嵴脑膜瘤可因视神经管受累而导致急性视觉症状。有必要尽早咨询神经外科医生。视觉诱发电位和光学相干断层扫描在随访视神经受压患者时敏感且有帮助。
