Ghahramani Aria, Camacci Mona L, Borkhetaria Rucha, Poulsen Anne, Beckstead Samuel, Weller Christopher
Penn State College of Medicine, Hershey, Pennsylvania, USA.
Department of Ophthalmology, Penn State College of Medicine, Hershey, Pennsylvania, USA.
Case Rep Ophthalmol. 2021 Jun 18;12(2):569-573. doi: 10.1159/000514188. eCollection 2021 May-Aug.
The aim of this report is to present a patient with traumatic optic nerve sheath hematoma (ONSH), a rare diagnosis with high potential for visual sequelae. This case involves a 41-year-old male who presented promptly following blunt trauma to the right eye and orbit that resulted in acute vision loss. Following computed tomography and ophthalmic examination, a diagnosis of ONSH was made and medical therapy with methylprednisolone was initiated. He reported significant improvements in visual symptoms following intravenous corticosteroid therapy. Although the patient reported significant improvements and had normal Snellen visual acuities in follow-up, he continued to have an inferior visual field defect at 1 week in the affected eye. ONSH causing subsequent localized compression of the optic nerve is a rare mechanism of traumatic optic neuropathy in patients following head trauma. The localized compartment syndrome of the optic nerve and subjective visual symptoms were relieved following corticosteroid therapy with no initial need for surgical decompression. Although central visual acuity returned to baseline, the patient had a persistent visual field defect and relative afferent pupillary defect.
本报告旨在介绍一例患有外伤性视神经鞘膜血肿（ONSH）的患者，这是一种罕见的诊断，具有导致视力后遗症的高风险。该病例涉及一名41岁男性，他在右眼和眼眶受到钝器伤后立即就诊，导致急性视力丧失。经过计算机断层扫描和眼科检查，诊断为ONSH，并开始使用甲基泼尼松龙进行药物治疗。他报告静脉注射皮质类固醇治疗后视觉症状有显著改善。尽管患者报告有显著改善，且随访时Snellen视力正常，但患眼在1周时仍存在下方视野缺损。头部外伤后患者中，ONSH导致视神经随后局部受压是外伤性视神经病变的一种罕见机制。皮质类固醇治疗后，视神经的局部间隔综合征和主观视觉症状得到缓解，最初无需手术减压。尽管中心视力恢复到基线水平，但患者仍有持续的视野缺损和相对传入性瞳孔障碍。
