Neurology, Maasstad Hospital, Rotterdam, Zuid-Holland, The Netherlands
Radiology, Maasstad Hospital, Rotterdam, Zuid-Holland, The Netherlands.
BMJ Case Rep. 2021 Jul 21;14(7):e237988. doi: 10.1136/bcr-2020-237988.
A 52-year-old male patient with polyarthritis nodosa (PAN) was referred to our neurology outpatient clinic. His main symptom was paroxysmal alternating bilateral blindness. Subsequently, he developed retro-orbital pain. Neurological examination including funduscopy was normal and laboratory tests showed no relevant abnormalities. MRI orbits showed remarkable perineural thickening and contrast enhancement of the optic nerve sheaths with sparing of the central optic nerve. These findings are pathognomonic for the clinical-radiological diagnosis of optic perineuritis (OPN). The patient was treated with high-dose immunosuppressants and had a good clinical outcome. Rapid diagnosis of OPN is important because early treatment is associated with a better outcome.
一位 52 岁男性多关节炎结节病（PAN）患者被转至我院神经内科门诊。其主要症状为阵发性交替性双侧失明。随后，他出现眼眶后疼痛。神经科检查包括眼底镜检查均正常，实验室检查无相关异常。眼眶 MRI 显示明显的神经鞘周围增厚和视神经鞘对比增强，而中央视神经不受累。这些发现是临床-放射学诊断视神经鞘炎（OPN）的特征性表现。该患者接受了大剂量免疫抑制剂治疗，临床结局良好。快速诊断 OPN 非常重要，因为早期治疗与更好的结局相关。
