Uniyal Ravi, Garg Ravindra Kumar, Malhotra Hardeep Singh, Kumar Neeraj, Pandey Shweta, Rizvi Imran, Jain Amita, Tejan Nidhi, Kirar Rupesh Singh
Department of Neurology, King George Medical University, Lucknow, India.
Department of Microbiology, King George Medical University, Lucknow, India.
Neuroophthalmology. 2023 Apr 5;47(4):225-229. doi: 10.1080/01658107.2023.2194987. eCollection 2023.
We report an interesting case of visual loss and visual hallucinations in a 37-year-old man. He presented with decreased vision in both eyes and visual hallucinations for the last one and a half months. He also had multiple focal to bilateral tonic-clonic seizures. On examination, there was no perception of light rays in both eyes. Fundus examination revealed disc oedema with peripapillary small haemorrhages in both eyes. Initially, the discs were hyperaemic, which turned pale in the subsequent examination at 1 month. Magnetic resonance imaging (MRI) of the brain revealed T2 hyperintensities in periventricular white matter and right fronto-parietal-occipital gray matter. His electroencephalogram showed intermittent slowing. His cerebrospinal fluid (CSF) examination showed five cells (all lymphocytes), protein 50 mg/dl, sugar 76 mg/dl (corresponding blood sugar 90 mg/dl). His CSF specimen was positive for anti-measles IgG antibodies. In conclusion, acute vision loss can rarely be the presenting symptom and, therefore, SSPE should also be considered in differential diagnoses of acute vision loss in measles-endemic regions.
我们报告了一例37岁男性出现视力丧失和视幻觉的有趣病例。他在过去一个半月出现双眼视力下降和视幻觉。他还出现了多次局灶性至双侧强直阵挛发作。检查时，双眼均无光感。眼底检查显示双眼视盘水肿伴视乳头周围小出血。最初，视盘充血，在1个月后的后续检查中变为苍白。脑部磁共振成像（MRI）显示脑室周围白质和右侧额顶枕灰质T2高信号。他的脑电图显示间歇性减慢。他的脑脊液（CSF）检查显示有5个细胞（均为淋巴细胞），蛋白50mg/dl，糖76mg/dl（相应血糖90mg/dl）。他的脑脊液标本抗麻疹IgG抗体呈阳性。总之，急性视力丧失很少作为首发症状出现，因此，在麻疹流行地区急性视力丧失的鉴别诊断中也应考虑亚急性硬化性全脑炎（SSPE）。
