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[假性福斯特肯尼迪综合征的诊断陷阱——病例报告]

[Diagnostic pitfalls of pseudo-foster kennedy syndrome - a case report].

作者信息

Michalec M, Vlková E, Matušková V, Vysloužilová D, Michalcová L

出版信息

Cesk Slov Oftalmol. 2014 Dec;70(6):242-7.

Abstract

To the outpatient facility of the Department of Ophthalmology, Faculty Hospital Brno, Czech Republic, E.U., was in June 2013 referred a 24 years old man with the suspicion of Foster Kennedy syndrome. On the fundus examinations, the findings were in correlation with the symptoms of this syndrome: slightly pale optic disc of the right eye and edema with the anterior extension of the optic nerve head of the left eye. The perimetric examination revealed bilateral visual fields defects, mainly in the nasal parts of the visual fields which is not typical for this syndrome. The native magnetic resonance imaging (MRI) examination was negative. Due to the suspicion of pathologic finding in the visual pathway area, the blood levels of pituitary gland hormones were examined and revealed elevated prolactin levels. In the indicated MRI examination with contrast, in the revised reading, a suspicious microadenoma of the pituitary gland was detected. Due to the atypical changes in the perimetric examinations, other possible causes of visual fields defects as coincidence of multiple, each other independent pathologies (neuritis or neuropathy of the optic nerve, neuromyelitis optica (Devic disease), Lebers hereditary optic neuritis (LHON) etc.) to exclude or to confirm the Pseudo-Foster Kennedy syndrome were taken into account. The patient is regularly followed up at our outpatient facility as well as at the outpatient facility of the Department of Neurosurgery, where, until now, the follow up only was recommended. The diagnosis of this case was, until now, set as Pseudo- Foster Kennedy syndrome, with unclarified cause of the clinical findings.

摘要

2013年6月,一名24岁男子因疑似福斯特·肯尼迪综合征被转诊至捷克共和国布尔诺市大学医院眼科门诊。眼底检查结果与该综合征症状相符:右眼视盘轻度苍白,左眼视神经乳头水肿并向前扩展。视野检查显示双侧视野缺损,主要位于视野鼻侧部分,这并非该综合征的典型表现。头颅磁共振成像(MRI)平扫检查结果为阴性。由于怀疑视路区域存在病变,对垂体激素水平进行了检测,结果显示催乳素水平升高。在增强MRI检查中,复查发现垂体有可疑微腺瘤。鉴于视野检查结果不典型,考虑到视野缺损的其他可能原因,如多种相互独立的病变同时存在(视神经炎或神经病、视神经脊髓炎(德维克病)、莱伯遗传性视神经病变(LHON)等),以排除或确诊假性福斯特·肯尼迪综合征。该患者在我们的门诊以及神经外科门诊定期接受随访,目前仅建议进行随访观察。到目前为止,该病例的诊断为假性福斯特·肯尼迪综合征,临床表现的病因尚不明确。

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