Division of Neurology, Department of Medicine, Department of Ophthalmology and Vision Sciences (JAM), University of Toronto, Toronto, Canada; Kensington Vision and Research Centre (JAM), Toronto, Canada; Department of Ophthalmology (JAM), St. Michael's Hospital, Toronto, Canada; Department of Laboratory Medicine (CJS), St. Michael's Hospital, Toronto, Canada; and Division of Respirology (KM), Department of Medicine, University of Toronto, St. Michael's Hospital, Toronto, Canada.
J Neuroophthalmol. 2020 Jun;40(2):255-257. doi: 10.1097/WNO.0000000000000822.
A 35-year-old healthy African-American woman presented with a 4-month history of gradual loss of vision in the right eye from an optic neuropathy. MRI of the orbits with gadolinium showed isolated thickening and enhancement of the right optic nerve sheath. Chest x-ray and CT-scan of the chest were performed and showed bilateral hilar and mediastinal lymphadenopathy. This was suggestive of sarcoidosis, and the diagnosis was confirmed with histopathology. The patient promptly recovered vision with high-dose corticosteroids; the thickening of the optic nerve sheath also regressed. Isolated optic nerve sheath thickening from sarcoidosis is rare and may mimic compressive optic neuropathies such as optic nerve sheath meningiomas. A systemic evaluation for systemic inflammatory etiologies should be considered in such cases.
一位 35 岁健康的非裔美国女性，因右眼视神经病变导致视力逐渐丧失 4 个月就诊。眼眶钆增强 MRI 显示右侧视神经鞘孤立性增厚和强化。进行了胸部 X 光和胸部 CT 扫描，显示双侧肺门和纵隔淋巴结病。这提示为结节病，组织病理学证实了这一诊断。患者迅速恢复了视力，使用了大剂量皮质类固醇；视神经鞘的增厚也消退了。孤立性视神经鞘增厚由结节病引起的情况较为罕见，可能类似于压迫性视神经病变，如视神经鞘脑膜瘤。在这种情况下，应考虑全身性炎症病因的系统性评估。
