一名患有颅内高压的年轻患者出现单侧扩展性岩尖脑膨出和对侧玻璃体出血。

Unilateral expanding petrous apex cephalocele and contralateral vitreous hemorrhage in a young patient with intracranial hypertension.

作者信息

Hanai Kaori, Hashimoto Masato, Nakamura Hirohiko

机构信息

Department of Ophthalmology, Nakamura Memorial Hospital, S-1, W-14, Chuo-ku. Sapporo, Hokkaido, Japan.

Department of Neurosurgery, Nakamura Memorial Hospital, S-1, W-14, Chuo-ku. Sapporo, Hokkaido, Japan.

出版信息

Am J Ophthalmol Case Rep. 2022 Jan 26;25:101368. doi: 10.1016/j.ajoc.2022.101368. eCollection 2022 Mar.

DOI:10.1016/j.ajoc.2022.101368

PMID:35146212

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8818526/

Abstract

PURPOSE

To report a case of unilateral petrous apex cephalocele (PAC) and contralateral vitreous hemorrhage in a young patient with intracranial hypertension.

OBSERVATIONS

A 12-year-old boy had acute visual loss in the right eye. The clinical and radiological findings were consistent with right vitreous hemorrhage with mild intracranial hypertension and left PAC. Cerebral angiography demonstrated low flow of the left inferior petrosal sinus and anterior venous high flow from the cavernous sinus to the facial vein via the superior ophthalmic vein. The presence of an expanding PAC, blocking the venous flow away from the inferior petrosal sinus, would produce an ipsilateral intraocular pressure (IOP) (20 mmHg) mildly higher than the other one (16 mmHg) although it is in the normal range, which may have caused the difference of the translaminar pressure gradient resulting from the balance between the cerebrospinal flow pressure and the IOP.

CONCLUSION AND IMPORTANCE

Unilateral expanding PAC may cause intracranial hypertension with different severity of papilledema between two eyes.

摘要

目的

报告一例患有颅内高压的年轻患者出现单侧岩尖脑膨出（PAC）及对侧玻璃体出血的病例。

观察结果

一名12岁男孩右眼急性视力丧失。临床和影像学检查结果与右侧玻璃体出血伴轻度颅内高压及左侧PAC相符。脑血管造影显示左侧岩下窦血流缓慢，且存在从前海绵窦经眼上静脉至面静脉的前静脉高血流。存在扩张性PAC，阻碍岩下窦的静脉血流，尽管眼压在正常范围内（右眼20 mmHg，左眼16 mmHg），但可导致患侧眼压略高于对侧，这可能导致了脑脊液流动压力与眼压平衡产生的跨筛板压力梯度差异。