Departments of Ophthalmology (MD, JW, CO), Neurology (MD, AEM), and Pathology (EL), Weill Cornell Medical College, New York, New York.
J Neuroophthalmol. 2019 Sep;39(3):313-318. doi: 10.1097/WNO.0000000000000722.
To describe a case of optic neuropathy associated with intravascular lymphoma (IVL).
Case report and review of the literature.
A case of asymmetric binocular vision loss is described, preceded by transient vision loss. Associated optic perineural enhancement and enhancing and diffusion-positive cortical lesions were observed on magnetic resonance imaging. Biopsy of the cerebellum revealed exclusively intraluminal neoplastic B-cells consistent with IVL.
Patients with IVL may rarely present with optic nerve involvement, presumably due to small vessel occlusion. The presentation may mimic features of anterior ischemic optic neuropathy including an acute onset and disc edema. Although optic nerve enhancement and associated white matter lesions may suggest optic neuritis, enhancement of the optic nerve sheath, as in this case, has a wide differential diagnosis, which includes giant cell arteritis. IVL should be considered in atypical cases of optic neuropathy accompanied by enhancing, diffusion-positive brain lesions that are not within a specific vascular territory.
描述一例与血管内淋巴瘤（IVL）相关的视神经病变。
病例报告和文献复习。
描述了一例不对称性双眼视力丧失的病例，此前曾出现短暂性视力丧失。磁共振成像观察到视神经周围增强，以及增强和弥散阳性皮质病变。小脑活检显示仅腔内肿瘤性 B 细胞，符合 IVL。
IVL 患者可能很少出现视神经受累，推测是由于小血管闭塞所致。其表现可能类似于前部缺血性视神经病变的特征，包括急性发作和视盘水肿。尽管视神经增强和相关的白质病变可能提示视神经炎，但视神经鞘增强，如本例所示，具有广泛的鉴别诊断，包括巨细胞动脉炎。在伴有增强、弥散阳性脑病变且不在特定血管区域的非典型视神经病变中，应考虑 IVL。
