新冠病毒感染后因硫胺素缺乏导致视力丧失的双侧视乳头水肿：病例说明
Bilateral papilledema with vision loss due to post-COVID-19-induced thiamine deficiency: illustrative case.
作者信息
Guppy Kern H, Axelrod Yekaterina K, Kim Han
机构信息
1Department of Neurosurgery, The Kaiser Permanente Medical Group, Sacramento, California.
2Department of Neurological Surgery, University of California, San Francisco, San Francisco, California; and.
出版信息
J Neurosurg Case Lessons. 2022 Sep 19;4(12). doi: 10.3171/CASE22332.
BACKGROUND
Bilateral papilledema with vision loss is considered a neurosurgical emergency due to high intracranial pressure. However, it may not be the only cause of papilledema. The authors reported an association among coronavirus disease 2019 (COVID-19), bilateral papilledema, blindness, and Wernicke's encephalopathy (WE).
OBSERVATIONS
An 18-year-old woman presented to the neurosurgery service with rapid profound vision loss and bilateral papilledema. She had COVID-19 3 months earlier with subsequent loss of smell (anosmia) and taste (ageusia), which resulted in hyperemesis and a 43-lb weight loss. Examination revealed ataxia, horizontal nystagmus, and blindness. Magnetic resonance imaging and magnetic resonance venography of her brain were normal. Presumptive diagnosis of WE was made, and she was treated with intravenous thiamine with restoration of vision within 48 hours. Patient's thiamine level was less than half the normal value.
LESSONS
Neurosurgeons should be aware of this unique correlation between papilledema and vision loss and its association with WE due to post-COVID-19 hyperemesis and weight loss from anosmia and ageusia.
背景
由于颅内压升高，双侧视乳头水肿伴视力丧失被视为神经外科急症。然而，它可能不是视乳头水肿的唯一原因。作者报告了2019冠状病毒病（COVID-19）、双侧视乳头水肿、失明和韦尼克脑病（WE）之间的关联。
观察结果
一名18岁女性因快速严重视力丧失和双侧视乳头水肿就诊于神经外科。她3个月前感染了COVID-19，随后出现嗅觉丧失（嗅觉减退）和味觉丧失（味觉障碍），导致剧烈呕吐和体重减轻43磅。检查发现共济失调、水平眼球震颤和失明。她脑部的磁共振成像和磁共振静脉造影均正常。初步诊断为WE，给予静脉注射硫胺素治疗，48小时内视力恢复。患者的硫胺素水平低于正常值的一半。
经验教训
神经外科医生应意识到视乳头水肿与视力丧失之间的这种独特关联，以及它与COVID-19后因嗅觉减退和味觉障碍导致的剧烈呕吐和体重减轻所引发的WE之间的关联。
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