Biousse V, Mendicino M E, Simon D J, Newman N J
Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA.
Am J Ophthalmol. 1998 Apr;125(4):527-44. doi: 10.1016/s0002-9394(99)80194-9.
To provide a practical review of the ophthalmologic manifestations of intracranial vascular abnormalities.
We reviewed ocular manifestations of the most common intracranial vascular abnormalities: intracranial aneurysms, carotid-cavernous fistulas, arteriovenous malformations, and cavernous malformations.
Unruptured aneurysms can compress the third cranial nerve and the anterior visual pathways. Ruptured aneurysms and subarachnoid hemorrhage can result in Terson syndrome and papilledema. Direct and indirect carotid-cavernous fistulas most commonly cause the classic triad of proptosis, conjunctival chemosis, and cranial bruit but can masquerade as chronic conjunctivitis. Arteriovenous malformations, with or without hemorrhage, may compress portions of the retrochiasmal pathways, causing visual field loss. Cavernous malformations, when in the brainstem, commonly cause abnormalities of supranuclear, nuclear, and fascicular ocular motility.
The ophthalmologist may be the first physician to encounter clinical manifestations of intracranial vascular abnormalities that may herald devastating neurologic complications. Prompt diagnosis facilitates appropriate management and therapy.
对颅内血管异常的眼科表现进行实用综述。
我们回顾了最常见的颅内血管异常的眼部表现：颅内动脉瘤、颈动脉海绵窦瘘、动静脉畸形和海绵状畸形。
未破裂的动脉瘤可压迫第三脑神经和前部视觉通路。破裂的动脉瘤和蛛网膜下腔出血可导致Terson综合征和视乳头水肿。直接和间接颈动脉海绵窦瘘最常引起眼球突出、结膜水肿和颅部杂音的典型三联征，但可伪装成慢性结膜炎。动静脉畸形，无论有无出血，都可能压迫视交叉后通路的部分区域，导致视野缺损。当海绵状畸形位于脑干时，通常会导致核上性、核性和束状眼球运动异常。
眼科医生可能是首位遇到颅内血管异常临床表现的医生，这些表现可能预示着毁灭性的神经并发症。及时诊断有助于进行适当的管理和治疗。
