Levine D N, Lee J M, Fisher C M
Neurology Service, Massachusetts General Hospital, Boston.
Neurology. 1993 Feb;43(2):305-13. doi: 10.1212/wnl.43.2.305.
A 59-year-old man developed problems with reading and driving. When first examined, he had great difficulty locating and identifying items by sight. Visual acuity was normal, but contrast sensitivity for low spatial frequencies was severely impaired. The peripheral visual fields were moderately constricted with depressed flicker fusion frequencies, more on the right. Color identification was preserved. The difficulties in identifying and locating objects by sight were aggravated by increasing the complexity and multiplicity of the items in the field of vision and by changing the ambient illumination. Intellect and memory were relatively intact, except for difficulty with calculations. Over a 12-year course the visual defects steadily worsened, and eventually memory and language skills failed. Social manners, perseverance, and affect remained normal. Postmortem examination showed cortical atrophy, predominantly posterior, with abundant neurofibrillary tangles and senile plaques. The density of the tangles was correlated with the severity of the atrophy, being highest in the occipitoparietal areas and lowest in the frontal lobes. Alzheimer's disease can preferentially affect the posterior cerebral hemispheres and cause a dementia presenting with, and dominated by, visual disturbances.
一名59岁男性出现阅读和驾驶方面的问题。初诊时，他通过视觉定位和识别物品存在极大困难。视力正常，但低空间频率的对比敏感度严重受损。周边视野中度收缩，闪烁融合频率降低，右侧更明显。颜色识别能力保留。通过增加视野中物品的复杂性和多样性以及改变环境照明，视觉识别和定位物体的困难会加剧。除了计算困难外，智力和记忆力相对完好。在12年的病程中，视觉缺陷逐渐恶化，最终记忆和语言能力衰退。社交礼仪、毅力和情感保持正常。尸检显示皮质萎缩，主要在后部，有大量神经原纤维缠结和老年斑。缠结的密度与萎缩的严重程度相关，在枕顶叶区域最高，额叶最低。阿尔茨海默病可优先影响大脑后半球，并导致以视觉障碍为表现且以其为主导的痴呆。
