Tripathi Anchal, Pandey Ashish, Gupta Radhika, Gupta Amul, Vichare Nitin, Ahmad Faiz
Department of Ophthalmology, Military Hospital, Jammu, Jammu and Kashmir, India.
Department of Radiology, Military Hospital, Jammu, Jammu and Kashmir, India.
Rom J Ophthalmol. 2025 Apr-Jun;69(2):259-266. doi: 10.22336/rjo.2025.41.
We report four unique neurological cases that initially presented with ophthalmological manifestations.
In the first case, a 36-year-old man came in with a left-sided headache and isolated third nerve palsy. Detailed investigations led to the discovery of a supraclinoid internal carotid artery aneurysm, necessitating prompt neurosurgical intervention. The second case featured a 74-year-old man with complete drooping of his right eyelid. The diagnosis of complete third nerve palsy led to further tests, which uncovered multiple myeloma. The third case involved a 19-year-old girl who had persistent double vision and bilateral ptosis. A collaborative effort between ophthalmologists and neurologists revealed Miller Fisher syndrome, which was successfully treated with intravenous immunoglobulins. Lastly, the fourth case described an 8-year-old girl who presented with optic neuritis. A thorough ophthalmological evaluation led to the diagnosis of Neuromyelitis Optica Spectrum Disorder, enabling early treatment and significant improvement.
These cases highlight the crucial role of ophthalmologists in identifying severe systemic and neurological conditions through subtle ocular signs. Each diagnosis-from aneurysms to autoimmune and malignant disorders-was made possible by vigilant ophthalmic evaluation and timely interdisciplinary collaboration. These examples reinforce that the eye often provides the first clue to an underlying disease, and that early recognition by ophthalmologists can be critical to effective, and sometimes lifesaving, intervention.
These cases collectively emphasize the critical importance of detailed ocular evaluation in the early detection and management of a wide range of neurological and systemic conditions, highlighting how ocular symptoms can often be the first indication of more serious underlying health issues.
我们报告4例最初表现为眼科症状的独特神经科病例。
第一例，一名36岁男性因左侧头痛和孤立性动眼神经麻痹前来就诊。详细检查发现鞍上颈内动脉瘤，需要立即进行神经外科干预。第二例是一名74岁男性，右眼完全下垂。完全性动眼神经麻痹的诊断促使进一步检查，结果发现了多发性骨髓瘤。第三例涉及一名19岁女孩，她持续出现复视和双侧上睑下垂。眼科医生和神经科医生共同努力诊断出米勒-费希尔综合征，通过静脉注射免疫球蛋白成功治愈。最后，第四例描述了一名8岁女孩，她出现视神经炎。全面的眼科评估诊断为视神经脊髓炎谱系障碍，得以早期治疗并显著改善。
这些病例突出了眼科医生通过细微眼部体征识别严重全身性和神经科疾病的关键作用。从动脉瘤到自身免疫性和恶性疾病的每一项诊断，都是通过警惕的眼科评估和及时的跨学科协作得以实现的。这些例子强化了眼睛常常为潜在疾病提供首要线索这一观点，以及眼科医生的早期识别对于有效干预（有时甚至是挽救生命的干预）至关重要。
这些病例共同强调了详细眼部评估在广泛的神经科和全身性疾病早期检测和管理中的至关重要性，突出了眼部症状如何常常是更严重潜在健康问题的首要迹象。
