Yoshida Kenji, Shirata Akiko, Sato Taku, Kishida Yugo, Saito Kiyoshi, Yamane Kiyomi
Department of Neurology, Neurological Institute, Ohta-Atami Hospital.
Rinsho Shinkeigaku. 2016;56(1):1-6. doi: 10.5692/clinicalneurol.cn-000741. Epub 2015 Nov 30.
A 71-year-old woman was admitted to our hospital complaining of left orbital pain, headache, diplopia and left-sided ptosis, which she had suffered for two months. On examination, the patient had loss of visual acuity, left-sided ptosis, lateral gaze disturbance, and was diagnosed as having left orbital apex syndrome. An abnormal signal to the left orbital cone was detected on MRI. Serum β-D-glucan was increased, and serum Aspergillus antigen and antibody were both positive. Although antifungal drugs (voriconazole and liposomal amphotericin B) were administered, the symptoms deteriorated. The patient then underwent optic nerve decompression surgery and was treated with intravenous methylprednisolone, which gradually improved the patient's symptoms, Aspergillus hyphae were confirmed by pathological examination. To obtain good prognosis for patients with orbital apex syndrome associated with Aspergillus infection, optic nerve decompression surgery should be considered.
一名71岁女性因左眼眶疼痛、头痛、复视和左侧上睑下垂两个月而入院。检查时，患者视力丧失、左侧上睑下垂、眼球外展障碍，被诊断为左眶尖综合征。MRI检测到左眼眶圆锥异常信号。血清β-D-葡聚糖升高，血清曲霉抗原和抗体均为阳性。尽管给予了抗真菌药物（伏立康唑和脂质体两性霉素B），但症状仍恶化。患者随后接受了视神经减压手术，并接受静脉注射甲泼尼龙治疗，症状逐渐改善，病理检查证实有曲霉菌丝。为使曲霉菌感染相关的眶尖综合征患者获得良好预后，应考虑行视神经减压手术。
