Zarei Sara, Vo Phuong, Sam Christian, Crow Robert W, Stout Charles, Al-Khoury Lama
Department of Neurology (SZ, LAK), HCA Healthcare, Nashville, TN; Riverside Community Hospital (SZ, CS), CA; School of Medicine (PV, CS), UCR, Riverside, CA; Department of Ophthalmology (RWC), UCI, Irvine, CA; and Department of Interventional Neurology (CS), HCA Healthcare, Nashville, TN.
Neurol Clin Pract. 2021 Oct;11(5):e706-e713. doi: 10.1212/CPJ.0000000000001090.
Acute bilateral blindness has an extensive differential diagnosis that requires a careful history and physical examination to narrow down. In this article, we discuss the pathophysiology and radiographic findings of each possible diagnosis for acute bilateral blindness.
Visual pathology with respect to bilateral blindness can be broadly broken down into 3 anatomic categories: media (i.e., the anterior and posterior chamber of the eye), retina, and neural visual pathway. Possible causes of rapid onset bilateral blindness include bilateral occipital infarcts, endogenous bacterial endophthalmitis, orbital cellulitis, orbital compartment syndrome, cavernous sinus thrombophlebitis, thyroid disease, and bilateral nonarteritic ischemic optic neuropathy.
In this case, we present a patient with acute onset of bilateral blindness, in addition to bilateral ophthalmoplegia, proptosis, and orbital chemosis. We believe that this rare case of acute bilateral blindness is thought provoking and aids in the understanding of the differential diagnosis and underlying pathophysiology of visual loss.
急性双侧失明的鉴别诊断范围广泛,需要详细的病史和体格检查来缩小诊断范围。在本文中,我们讨论急性双侧失明每种可能诊断的病理生理学和影像学表现。
双侧失明的视觉病理学可大致分为3个解剖学类别:介质(即眼球的前房和后房)、视网膜和神经视觉通路。急性双侧失明的可能原因包括双侧枕叶梗死、内源性细菌性眼内炎、眼眶蜂窝织炎、眼眶间隔综合征、海绵窦血栓性静脉炎、甲状腺疾病和双侧非动脉性缺血性视神经病变。
在本病例中,我们介绍了一名急性双侧失明患者,同时伴有双侧眼肌麻痹、眼球突出和眼眶结膜水肿。我们认为,这一罕见的急性双侧失明病例发人深省,有助于理解视力丧失的鉴别诊断和潜在病理生理学。