Mazzurco Marina, Pavone Piero, Di Luca Milena, Smilari Pierluigi, Pustorino Elena, Fiumara Agata, Di Mauro Paola, Greco Filippo, Cocuzza Salvatore
Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
ENT Unit, Department of Otorhinolaryngology, University of Catania, Italy.
Neuropediatrics. 2019 Dec;50(6):341-345. doi: 10.1055/s-0039-1693156. Epub 2019 Jul 22.
Optic neuropathy consists of several etiological events. The primary etiologies of its acute form include optic neuritis, ischemic optic neuropathy, inflammatory (nondemyelinating) disorders, and trauma. Its subacute and chronic forms are most often linked to compressive, toxic, nutritional, or hereditary-genetic causes. Visual loss, dyschromatopsia, and visual field defects are the presenting symptoms. The Onodi cell (sphenoethmoidal air cell) is an anatomic variant located laterally and superior to the sphenoid sinus; it is closely related to the optic nerve. Onodi cell disorders are rare and may be unnoticed in differential diagnoses of patients with ocular and neurological manifestations. Here, we present the case of a 12-year-old boy with headache and acute loss of sight characterized by hemianopsia in the left eye and retrobulbar optic neuropathy caused by left sphenoethmoidal sinusitis with the presence of Onodi cell inflammation. The diagnosis was confirmed by multilayered paranasal computed tomography and cerebral magnetic resonance imaging. Therapeutic treatment resulted in gradual improvement: at the 2-week follow-up, the patient no longer had headaches and his visual acuity returned to normal. Inflammation of Onodi cells should be considered in children with headache and abnormal vision.
视神经病变由多种病因引起。其急性形式的主要病因包括视神经炎、缺血性视神经病变、炎症性（非脱髓鞘性）疾病和外伤。其亚急性和慢性形式最常与压迫性、中毒性、营养性或遗传 - 基因性病因有关。视力丧失、色觉异常和视野缺损是主要症状。蝶筛隐窝气房（Onodi气房）是一种位于蝶窦外侧上方的解剖变异；它与视神经密切相关。Onodi气房病变罕见，在有眼部和神经症状患者的鉴别诊断中可能未被注意到。在此，我们报告一例12岁男孩，以头痛和急性视力丧失为特征，表现为左眼偏盲和球后视神经炎，由左侧蝶筛窦炎伴Onodi气房炎症引起。多层鼻窦计算机断层扫描和脑部磁共振成像确诊了该诊断。治疗后病情逐渐改善：在2周的随访中，患者不再头痛，视力恢复正常。对于有头痛和视力异常的儿童，应考虑Onodi气房炎症。
