Department of Neurology (DW, TH, SJ), University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Birmingham Neuro-Ophthalmology Unit (SPM), Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Department of Neuroradiology (SR), University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; and Department of Neuropathology (SN), University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
J Neuroophthalmol. 2019 Sep;39(3):411-415. doi: 10.1097/WNO.0000000000000842.
A 36-year-old woman presented with intermittent fever, nausea and vomiting, generalized polyarthralgias, and bilateral optic disc swelling. She had a history of difficult-to-control myasthenia gravis since the age of 18 years. Lumbar puncture demonstrated a normal opening pressure; cerebrospinal fluid (CSF) was remarkable for high protein, low glucose, and a mononuclear pleocytosis. Although initial MRI of the brain was normal, a repeat study 8 weeks later revealed enlarged and enhancing bilateral intraorbital and intracranial optic nerves. After a nondiagnostic brain biopsy, a CSF sample tested positive for antibodies to glial fibrillary acidic protein (GFAP). Findings in this case indicate that optic nerve swelling encountered in GFAP meningoencephalomyelitis is more likely due to optic nerve inflammation rather than elevated intracranial pressure.
一位 36 岁女性以间歇性发热、恶心和呕吐、全身性多关节炎以及双侧视盘肿胀为主要表现。她自 18 岁起患有难以控制的重症肌无力。腰椎穿刺显示正常的颅内压；脑脊液（CSF）的特点是高蛋白、低糖和单核细胞增多。尽管最初的脑部 MRI 正常，但 8 周后再次检查发现双侧眶内和颅内视神经增大和增强。在进行了一次无诊断意义的脑部活检后，CSF 样本检测出针对神经胶质纤维酸性蛋白 (GFAP) 的抗体呈阳性。该病例的结果表明，GFAP 脑膜脑炎中遇到的视神经肿胀更可能是由于视神经炎症而不是颅内压升高所致。
