O'Duffy D, James B, Elston J
Oxford Eye Hospital, UK.
Acta Ophthalmol Scand. 1998 Feb;76(1):119-20. doi: 10.1034/j.1600-0420.1998.760125.x.
Gaze-evoked amaurosis is transient monocular visual loss induced by an eccentric position of gaze, most frequently associated with orbital mass lesions. To our knowledge, there has been no reported case of idiopathic intracranial hypertension as a cause of gaze-evoked amaurosis. We present the hypothesis that in an eccentric position of gaze, ischaemic compression of a tense dilated optic nerve sheath results in further elevation of intrasheath pressure compromising blood flow to the retina.
We describe a case of unilateral gaze-evoked amaurosis and headaches in a 46 year old man diagnosed with idiopathic intracranial hypertension. He did not respond to medical treatment and had optic nerve sheath decompressions.
Following surgery, this patient's visual function improved with resolution of his gaze-evoked amaurosis.
Raised intracranial pressure associated with a tense dilated optic nerve sheath should be considered in the differential diagnosis of gaze-evoked amaurosis.
注视诱发的黑矇是由偏心注视位置引起的短暂性单眼视力丧失，最常与眶内肿块病变相关。据我们所知，尚无特发性颅内高压导致注视诱发黑矇的病例报道。我们提出一个假说，即在偏心注视位置时，紧张扩张的视神经鞘膜的缺血性压迫会导致鞘内压力进一步升高，从而损害视网膜的血流。
我们描述了一例46岁诊断为特发性颅内高压的男性患者，出现单侧注视诱发黑矇和头痛。他对药物治疗无反应，接受了视神经鞘膜减压术。
手术后，该患者的视觉功能改善，注视诱发的黑矇症状消失。
在注视诱发黑矇的鉴别诊断中，应考虑与紧张扩张的视神经鞘膜相关的颅内压升高。
