Braun Alanna, Doniger Stephanie J
From the *Pediatric Residency Program and †Division of Emergency Medicine, UCSF Benioff Children's Hospital Oakland, Oakland, CA.
Pediatr Emerg Care. 2014 Jul;30(7):505-7. doi: 10.1097/PEC.0000000000000172.
We present 2 cases of asymptomatic patients who were found to have raised and blurred optic discs on physical examination, suggestive of papilledema. Evaluation in the emergency department revealed 2 well-appearing children with normal vital signs and neurologic evaluation results, without symptoms of increased intracranial pressure. Point-of-care ocular ultrasonography was performed on both children, demonstrating calcification at the optic nerve, which is diagnostic of optic disc drusen. Optic disc drusen is caused by the deposition of calcified axonal debris and is often buried within the optic disc in pediatric patients. It can cause some changes in visual acuity and visual fields, but patients who are otherwise asymptomatic can be easily diagnosed through point-of-care ultrasound, thereby sparing patients an aggressive workup if their clinical picture is otherwise reassuring.
我们报告2例无症状患者,他们在体格检查中被发现视盘隆起且边界模糊,提示为视乳头水肿。急诊科的评估显示,这2名儿童外观良好,生命体征正常,神经学评估结果正常,没有颅内压升高的症状。对这两名儿童均进行了即时眼部超声检查,结果显示视神经处有钙化,这对视盘小体具有诊断意义。视盘小体是由钙化的轴突碎片沉积引起的,在儿科患者中通常埋藏于视盘内。它可导致视力和视野出现一些变化,但对于其他方面无症状的患者,通过即时超声检查很容易诊断,从而避免在临床表现令人安心的情况下对患者进行激进的检查。