Brew B J, Garrick R, Connelley T J
Department of Neurology, St Vincent's Hospital, Sydney, New South Wales.
Clin Exp Neurol. 1987;23:233-5.
The causes of visual loss in benign intracranial hypertension are related to long standing papilloedema, ischaemic optic neuropathy or haemorrhage into a subretinal neovascular membrane. Decompression procedures generally preserve or improve visual acuity but surgical treatment with subtemporal decompression may lead to visual impairment. Such a deficit has been recorded in the past as occurring with ventriculography. Postulated mechanisms have included brain herniation, spasm of vessels supplying the visual cortices or retinal vascular disturbance. To our knowledge treatment with lumboperitoneal shunting has not previously been reported as leading to further significant visual loss in this condition. This report describes such an occurrence in a patient. Retinal vascular disturbance is postulated on the basis of several normal CT scans, normal CSF pressure measured after surgery and visual evoked responses suggesting retinal or optic nerve damage.
良性颅内高压导致视力丧失的原因与长期存在的视乳头水肿、缺血性视神经病变或视网膜下新生血管膜出血有关。减压手术通常可保留或提高视力，但颞下减压的手术治疗可能导致视力损害。过去曾有记录表明脑室造影会出现这种视力缺陷。推测的机制包括脑疝、供应视皮质的血管痉挛或视网膜血管紊乱。据我们所知，以前尚未报道过腰大池腹腔分流术治疗这种疾病会导致进一步的严重视力丧失。本报告描述了一名患者出现这种情况。基于多次正常的CT扫描、手术后测量的正常脑脊液压力以及提示视网膜或视神经损伤的视觉诱发电位，推测存在视网膜血管紊乱。
