Shinkai Akihiro, Shinmei Yasuhiro, Takahashi Akihiro, Nakamura Kayoko, Tagawa Yoshiaki, Chin Shinki, Ishida Susumu
Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine Hokkaido University, Sapporo, Japan.
Higashi-Sapporo Neurology and Neurosurgery Clinic, Sapporo, Japan.
Am J Ophthalmol Case Rep. 2022 Mar 15;26:101478. doi: 10.1016/j.ajoc.2022.101478. eCollection 2022 Jun.
Cerebrospinal fluid hypovolemia syndrome (CHS) is a rare clinical entity that can be caused by spontaneous cerebrospinal fluid (CSF) leakage. The aim of this study is to report a rare case of CHS after a traffic accident in a patient who presented with diplopia and ptosis with fluctuation and was initially diagnosed with ocular myasthenia gravis.
A 29-year-old man exhibited fluctuating left ptosis and diplopia after a traffic accident. Although he was suspected of having myasthenia gravis and was treated using oral pyridostigmine bromide, his symptoms did not improve. He also had orthostatic headaches and malaise after the accident. His symptoms were suspected to be associated with traumatic cerebrospinal fluid hypovolemia. After 1000-mL fluid replacement, his diplopia and ptosis improved, and orbital T2-weghted MRI detected a high-signal zone around the optic nerve. We diagnosed him with oculomotor nerve paresis associated with cerebrospinal fluid hypovolemia. The symptoms, including ptosis, diplopia, orthostatic headaches, and malaise, disappeared after epidural blood patch therapy.
When treating patients with fluctuating ocular symptoms, such as diplopia and ptosis, who have a history of trauma and orthostatic headaches, the possibility of CHS should be considered in the differential diagnosis.
脑脊液低血容量综合征（CHS）是一种罕见的临床病症，可由自发性脑脊液（CSF）漏引起。本研究的目的是报告1例交通事故后出现复视和上睑下垂且症状波动、最初被诊断为眼肌型重症肌无力的CHS罕见病例。
一名29岁男性在交通事故后出现左侧上睑下垂和复视症状波动。尽管怀疑他患有重症肌无力并使用口服溴吡斯的明进行治疗，但他的症状并未改善。事故后他还出现体位性头痛和不适。怀疑他的症状与外伤性脑脊液低血容量有关。补充1000毫升液体后，他的复视和上睑下垂症状有所改善，眼眶T2加权磁共振成像（MRI）检测到视神经周围有一个高信号区。我们诊断他为与脑脊液低血容量相关的动眼神经麻痹。硬膜外血贴治疗后，包括上睑下垂、复视、体位性头痛和不适在内的症状消失。
在治疗有外伤史且有体位性头痛、出现复视和上睑下垂等眼部症状波动的患者时，鉴别诊断中应考虑CHS的可能性。
