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一名慢性肾脏病患者的视盘水肿:诊断难题

Disc Oedema in A Patient with Chronic Kidney Disease: A Diagnostic Conundrum.

作者信息

Sutraye Jagadeesh, Kannam Mohan, Ponnapalli Srinivasa Perraju, Sachdeva Virender

机构信息

Academy of Eye Care Education, Child Sight Institute, Nimmagadda Prasad Children's Eye Care Centre, L V Prasad Eye Institute, Visakhapatnam, India.

Consultant Neuroradiologist, Vijaya Medical Centre, Visakhapatnam, India.

出版信息

Neuroophthalmology. 2021 Apr 20;46(1):34-40. doi: 10.1080/01658107.2020.1867872. eCollection 2022.

Abstract

A 47-year-old woman who presented with headache and blurring of vision was referred to us due to suspicion of idiopathic intracranial hypertension or cerebral sinus venous thrombosis. She had chronic kidney disease and underwent dialysis through multiple ports including the right internal jugular vein (IJV). Her examination showed a best corrected visual acuity of 20/20 in each eye, normal anterior segments in each eye but bilateral papilloedema. Magnetic resonance imaging and venography (MRV) of her brain with contrast showed signs of raised intracranial pressure and a hypoplastic left transverse sinus. An MRV of her neck showed a thrombosis of the right IJV. Her symptoms and papilloedema resolved with carbonic anhydrase inhibitors and anticoagulants. This case highlights an uncommon presentation of papilloedema secondary to raised intracranial pressure from IJV thrombosis and its pathogenesis.

摘要

一名47岁女性因头痛和视力模糊就诊,因怀疑特发性颅内高压或脑静脉窦血栓形成被转诊至我院。她患有慢性肾脏病,通过包括右颈内静脉(IJV)在内的多个通路进行透析。她的检查显示双眼最佳矫正视力均为20/20,双眼眼前节正常,但双侧视乳头水肿。脑部增强磁共振成像和静脉造影(MRV)显示颅内压升高和左侧横窦发育不全的迹象。颈部MRV显示右颈内静脉血栓形成。她的症状和视乳头水肿通过碳酸酐酶抑制剂和抗凝剂得到缓解。该病例突出了因颈内静脉血栓形成导致颅内压升高继发视乳头水肿的罕见表现及其发病机制。

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