Kasundra Gaurav M, Sood Isha, Prakash Sanjay, Mehta Dhruv P
Department of Neurology, Dr. Sampurnanand Medical College and Mahatma Gandhi Hospital, Jodhpur, Rajasthan, India.
Department of Medicine, Dr. Sampurnanand Medical College and Mahatma Gandhi Hospital, Jodhpur, Rajasthan, India.
J Pediatr Neurosci. 2014 May;9(2):172-4. doi: 10.4103/1817-1745.139347.
We report a 13-year-old female patient having vertigo and visual blurring since 2 weeks with blood pressure being 180/106 mmHg. Fundus examination showed optic disc edema with macular star. After ruling out infective causes, idiopathic neuroretinitis was diagnosed. Her brain magnetic resonance imaging (MRI) scan revealed three periventricular morphologically multiple sclerosis (MS)-like white matter lesions. Renal ultrasound and renal arteriogram showed a shrunken left kidney, small non-stenotic left renal artery and reduced vessels in upper pole of left kidney, consistent with Ask-Upmark kidney (AUK). Her symptoms improved with antihypertensive drugs. Follow-up MRI at 1 year revealed no interval change, while fundus had normalized. Neuroretinitis typically has normal brain MRI and rules out MS. However, our patient having AUK-induced hypertension had neuroretinitis and MS-like brain lesions and did not fulfill diagnostic criteria for MS. Thus we postulate that MS-like lesions can be part of neuroretinitis, especially in hypertensive patients.
我们报告一名13岁女性患者，自两周前起出现眩晕和视物模糊，血压为180/106 mmHg。眼底检查显示视盘水肿伴黄斑星芒状渗出。排除感染性病因后，诊断为特发性神经视网膜炎。她的脑部磁共振成像（MRI）扫描显示脑室周围有三个形态上类似多发性硬化（MS）的白质病变。肾脏超声和肾动脉造影显示左肾缩小，左肾动脉无狭窄且左肾上极血管减少，符合Ask-Upmark肾（AUK）表现。她的症状在使用降压药物后有所改善。1年后的随访MRI显示病变无变化，而眼底已恢复正常。神经视网膜炎通常脑部MRI正常，可排除MS。然而，我们这名患有AUK所致高血压的患者既有神经视网膜炎又有类似MS的脑部病变，且不符合MS的诊断标准。因此我们推测，类似MS的病变可能是神经视网膜炎的一部分，尤其是在高血压患者中。
