Freedman Isaac G, Kohli Anita A
Department of Ophthalmology and Visual Sciences, Yale School of Medicine, New Haven, Connecticut, USA.
Department of Ophthalmology and Visual Sciences, Yale School of Medicine, New Haven, Connecticut, USA
BMJ Case Rep. 2021 May 24;14(5):e240254. doi: 10.1136/bcr-2020-240254.
A 48-year-old woman with untreated hypothyroidism initially presented with tinnitus and hearing loss, followed by blurred vision and eye pain months later. Ophthalmic evaluation revealed no optic disc oedema. Visual field defects in both eyes suggested retrobulbar optic neuropathy. MRI of the brain and orbits demonstrated enhancement of both optic nerve sheaths and diffuse pachymeningeal enhancement. Audiologic evaluation revealed hearing loss in both ears, and frequent square wave jerks were seen on videonystagmography. Fine needle aspiration from one pulmonary lymph node showed non-necrotising granulomatous inflammation, confirming the diagnosis of neurosarcoidosis. The visual fields improved significantly on prednisone, and she is maintained on prednisone, infliximab and methotrexate. Though common, multiple cranial neuropathies in neurosarcoidosis are poorly represented in the literature. Clinicians should be aware of the symptoms that may herald a diagnosis of neurosarcoidosis, so that treatment may be implemented sooner, and further cranial neuropathies may be prevented.
一名48岁未接受治疗的甲状腺功能减退症女性最初出现耳鸣和听力丧失，数月后出现视力模糊和眼痛。眼科评估未发现视盘水肿。双眼视野缺损提示球后视神经病变。脑部和眼眶的MRI显示双侧视神经鞘强化及弥漫性硬脑膜强化。听力学评估显示双耳听力丧失，视频眼震图检查发现频繁的方波急跳。对一个肺门淋巴结进行细针穿刺显示非坏死性肉芽肿性炎症，确诊为神经结节病。使用泼尼松后视野明显改善，她目前维持使用泼尼松、英夫利昔单抗和甲氨蝶呤治疗。尽管神经结节病中的多发性颅神经病变很常见，但文献报道较少。临床医生应了解可能预示神经结节病诊断的症状，以便能更早地进行治疗，并预防进一步的颅神经病变。
