Mansukhani Sasha, Ho Mai-Lan, Bradley Elizabeth A, Brodsky Michael C
Departments of Ophthalmology, Mayo Clinic, Rochester, MN, USA.
Departments of Neurology, Mayo Clinic, Rochester, MN, USA.
Am J Ophthalmol Case Rep. 2019 Aug 2;16:100534. doi: 10.1016/j.ajoc.2019.100534. eCollection 2019 Dec.
This report describes accelerated visual recovery in a child following protracted hypoxic cortical visual loss and reviews mechanisms responsible for visual recovery.
A 12-year-old boy developed cortical blindness after a severe snowboarding crash. Magnetic resonance imaging showed severe multifocal hypoxic brain injury, with multifocal restricted diffusion and extensive T2/FLAIR hyperintensities throughout the visual cortex, basal ganglia and midbrain. The mismatch of affected areas on FLAIR and DWI sequences indicated a combination of cytotoxic and vasogenic edema, which suggested partial reversibility with potential for recovery. Two weeks after his injury, he began to experience an accelerated improvement in vision with recovery of 20/20 visual acuity and 40 sec/arc stereoacuity over the following week. Three months later, visual field examination showed a steep-margined horizontal band of spared visual field, which showed further expansion on repeat testing 1 year later.
Protracted hypoxic cortical visual loss can be followed by dramatic visual recovery in children. Magnetic resonance imaging can provide useful prognostic information.
本报告描述了一名儿童在长期缺氧性皮质视觉丧失后视觉快速恢复的情况，并回顾了视觉恢复的相关机制。
一名12岁男孩在严重的单板滑雪事故后出现皮质盲。磁共振成像显示严重的多灶性缺氧性脑损伤，在整个视觉皮层、基底神经节和中脑有多灶性扩散受限及广泛的T2/FLAIR高信号。FLAIR序列和弥散加权成像（DWI）序列上受影响区域的不匹配表明存在细胞毒性水肿和血管源性水肿，提示部分可逆且有恢复潜力。受伤两周后，他开始出现视力快速改善，在接下来的一周内恢复到20/20的视力和40秒/角秒的立体视锐度。三个月后，视野检查显示有一条边缘陡峭的水平保留视野带，在1年后的重复检查中进一步扩大。
儿童长期缺氧性皮质视觉丧失后可出现显著的视觉恢复。磁共振成像可提供有用的预后信息。
