Cheng-Tagome Shaohua, Yamamoto Akitaka, Suzuki Kei, Katayama Naoyuki, Imai Hiroshi
Emergency and Critical Care Center Mie University Hospital Tsu Mie Japan.
Department of Hematology and Oncology Mie University Graduate School of Medicine Tsu Mie Japan.
Acute Med Surg. 2016 Jul 1;4(1):109-113. doi: 10.1002/ams2.225. eCollection 2017 Jan.
Cortical blindness induced by hepatic encephalopathy is an extremely rare complication and its epidemiology has not been studied in great detail. We report a 63-year-old man with liver cirrhosis who developed sudden bilateral visual impairment.
On arrival at hospital, the patient had orientation disturbance, slurred speech, and mild disturbance of consciousness with impaired vision (light sense). He had no focal neurological deficits except for bilateral blindness. Cerebral stroke was suspected, but imaging and ophthalmological examination did not reveal major abnormalities. An increased concentration of ammonia in blood suggested hepatic encephalopathy; a diagnosis of cortical blindness was proposed. His vision returned gradually with relief of hepatic encephalopathy.
Cortical blindness can be an initial symptom of hepatic encephalopathy without severe disturbance of consciousness, and can be misdiagnosed as cerebral stroke. Cortical blindness induced by hepatic encephalopathy has been reported in only 10 cases, including our patient, and merits further evaluation.
肝性脑病所致皮质盲是一种极为罕见的并发症，其流行病学尚未得到详细研究。我们报告一名63岁肝硬化男性，他突然出现双侧视力障碍。
入院时，患者存在定向障碍、言语含糊不清，并有轻度意识障碍及视力受损（光感）。除双侧失明外，他没有局灶性神经功能缺损。怀疑为脑卒中，但影像学和眼科检查未发现重大异常。血液中氨浓度升高提示肝性脑病；提出皮质盲的诊断。随着肝性脑病的缓解，他的视力逐渐恢复。
皮质盲可能是肝性脑病的首发症状，而无严重意识障碍，且可能被误诊为脑卒中。包括我们的患者在内，仅有10例报告了肝性脑病所致皮质盲，值得进一步评估。
