Johnson M W, Kincaid M C, Trobe J D
WK Kellogg Eye Center, Ann Arbor, MI 48105-1994.
Ophthalmology. 1987 Dec;94(12):1577-84. doi: 10.1016/s0161-6420(87)33236-1.
A 59-year-old woman with anemia became totally blind after repeated gastrointestinal bleeding and acute hypotension. Neuropathologic examination was normal apart from bilateral infarctions centered on the orbital portion of the optic nerves. This is the only "pure" histopathologic study of visual loss after hemorrhage and hypotension in the recent literature, the single previous case being complicated by arteriosclerosis and vasculitis. The authors suggest that visual loss after hypotension is of three types. Profound hypotension in patients with neither anemia nor arteriosclerosis generally causes water-shed infarctions in the parietal and occipital lobes. Brief hypotension combined with arteriosclerosis favors juxtalaminar optic nerve infarction indistinguishable from spontaneous anterior ischemic optic neuropathy. In anemic patients without arteriosclerotic risk factors, hypotension is likely to cause infarction in the orbital optic nerve, where pial end vessels are subject to compression from hypoxic edema.
一名59岁的贫血女性在反复胃肠道出血和急性低血压后完全失明。神经病理学检查除了以视神经眶部为中心的双侧梗死外均正常。这是近期文献中关于出血和低血压后视力丧失的唯一一项“纯”组织病理学研究，之前的唯一病例合并有动脉硬化和血管炎。作者认为低血压后的视力丧失有三种类型。既无贫血也无动脉硬化的患者发生严重低血压通常会导致顶叶和枕叶的分水岭梗死。短暂低血压合并动脉硬化则易发生与自发性前部缺血性视神经病变难以区分的视神经层旁梗死。在没有动脉硬化危险因素的贫血患者中，低血压很可能导致眶部视神经梗死，此处软脑膜终末血管易受缺氧性水肿的压迫。
