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[一名患有眼部白化病的女性继发眼球震颤:一项诊断挑战]

[Nystagmus secondary to albinism with ocular involvement in a female: A diagnostic challenge].

作者信息

Schonhaut B Luisa, Britzmann L Joanna, Zanolli S Mario, Pavlov N Jovanka, Hasbun Z Trinidad, Repetto L Gabriela

机构信息

Departamento de Pediatría, Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile.

Hospital Dr. Luis Calvo Mackenna, Santiago, Chile.

出版信息

Rev Chil Pediatr. 2020 Aug;91(4):573-578. doi: 10.32641/rchped.vi91i4.1240. Epub 2020 Jun 23.

DOI:10.32641/rchped.vi91i4.1240
PMID:33399735
Abstract

INTRODUCTION

Infantile nystagmus is an infrequent condition that represents a diagnostic challenge for the pediatri cian. Albinism is one of its main causes, being difficult to suspect in the absence of evident cutaneous involvement, especially in female patients, due to the inheritance type of ocular albinism. Objec tive: To describe a case of nystagmus secondary to albinism with isolated ocular involvement in a female patient, in order to provide tools for pediatric approach and diagnosis.

CLINICAL CASE

Three- weeks-old female patient, without morbid history, referred to a pediatric neurosurgeon and ophthal mologist due to paroxysmal eye movements since 2 weeks of age. The electroencephalogram and brain images were normal. In follow-up monitoring at 3 months, iris translucency, nystagmus, and hypermetropic astigmatism were confirmed. Dermatologic evaluation ruled out cutaneous invol vement. The patient developed cephalic downward inclination and coordination development de lay was confirmed, the patient was handled with corrective lenses and kinesiotherapy. In follow-up monitoring at 3 years, there was an improvement in visual acuity, decreased nystagmus and normal neurodevelopment. The ophthalmological evaluation of both parents was normal and there was no history of nystagmus or albinism in the family. Upon her parents' decision, no genetic study was ca rried out.

CONCLUSION

The diagnosis of nystagmus secondary to ocular albinism, even in the absence of cutaneous involvement, is clinical. The genetic study allows confirming the etiology, without being an essential examination, unless family planning is considered. Timely research and multidisciplinary intervention determine a better prognosis.

摘要

引言

婴儿眼球震颤是一种罕见病症,对儿科医生来说是一项诊断挑战。白化病是其主要病因之一,由于眼部白化病的遗传类型,在没有明显皮肤受累的情况下,尤其是女性患者,很难怀疑患有该病。目的:描述一例女性患者因白化病继发眼球震颤且仅有眼部受累的病例,以便为儿科诊疗和诊断提供方法。

临床病例

一名3周大的女性患者,无病史,因自2周龄起出现阵发性眼球运动,转诊至儿科神经外科医生和眼科医生处。脑电图和脑部影像均正常。在3个月的随访监测中,证实存在虹膜半透明、眼球震颤和远视散光。皮肤科评估排除了皮肤受累。患者出现头部向下倾斜,且证实存在协调发育延迟,对该患者使用了矫正眼镜并进行了运动疗法。在3岁的随访监测中,视力有所改善,眼球震颤减轻,神经发育正常。对其父母进行的眼科评估正常,且家族中无眼球震颤或白化病病史。根据其父母的决定,未进行基因研究。

结论

即使在没有皮肤受累的情况下,眼部白化病继发眼球震颤的诊断也是临床诊断。基因研究有助于确诊病因,但并非必要检查,除非考虑计划生育。及时的研究和多学科干预可带来更好的预后。

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