Shibata K, Uchiyama S, Tei H, Shibagaki Y, Maruyama S
Department of Neurology, Tokyo Women's Medical College.
Rinsho Shinkeigaku. 1994 Mar;34(3):241-5.
We reported a rare case of cortical blindness in cerebral ischemia following post-anoxic state confirmed by single photon emission computerized tomography (SPECT) and visual evoked potential. A 45-year-old woman who had been suffering from bronchial asthma was admitted to our hospital because of sudden progressive dyspnea and depressed consciousness. When she arrived at the hospital by ambulance, she was in hypoxic state and fell into cardiac arrest. Her respiratory condition gradually improved with respirator assistance, and she recovered consciousness, but complained of bilateral visual loss. She had no history of any neurological or psychiatric illness, nor of drug abuse. On neurological examination, she was alert and oriented. Light reflex, optic fundi, extraocular movement and other neurological findings were all normal, with the exception of bilateral blindness. EEG showed generalized slow background activity, but cranial CT scan and MRI showed no abnormalities. 99mTc-HMPAO SPECT indicated hypoperfusion in prominent bilateral occipital and parietal lobes. Simultaneous recordings of pattern reversal visual evoked potential (VEP) and electroretinograms (ERG) using transient checkerboard pattern reversal in 15 min and 30 min checks were recorded. The results showed normal b waves but absent P100 in the bilateral eyes. From the patient's neurological symptoms and the results of SPECT and VEP, she was diagnosed as cortical blindness in post-anoxic state. On the 30th hospital day, her visual acuity and visual fields improved, but she was suspected of having visual agnosia. Eighty-five days after the onset of the neurological abnormalities, no traces of visual disturbances were observed.(ABSTRACT TRUNCATED AT 250 WORDS)
我们报告了一例罕见的缺氧后状态下脑缺血导致皮质盲的病例，该病例经单光子发射计算机断层扫描（SPECT）和视觉诱发电位证实。一名45岁患有支气管哮喘的女性因突发进行性呼吸困难和意识障碍入住我院。当她被救护车送到医院时，处于缺氧状态并陷入心脏骤停。在呼吸机辅助下，她的呼吸状况逐渐改善，意识恢复，但诉说双眼视力丧失。她没有任何神经或精神疾病史，也没有药物滥用史。神经系统检查时，她神志清醒，定向力正常。除双侧失明外，光反射、眼底、眼球运动及其他神经系统检查结果均正常。脑电图显示广泛的慢背景活动，但头颅CT扫描和MRI均无异常。99mTc-HMPAO SPECT显示双侧枕叶和顶叶明显灌注不足。在15分钟和30分钟检查时，使用瞬态棋盘格反转同时记录了模式反转视觉诱发电位（VEP）和视网膜电图（ERG）。结果显示双眼b波正常但P100缺失。根据患者的神经症状以及SPECT和VEP的结果，她被诊断为缺氧后状态下的皮质盲。在住院第30天时，她的视力和视野有所改善，但怀疑有视觉失认症。神经异常发作85天后，未观察到视觉障碍的痕迹。（摘要截选至250字）
