第145例头痛，伴有眼前闪光.doc

第145例 头痛，伴有眼前闪光Yyzzhh战友： 30岁，男性患者。2001年10月，患者头痛，伴有眼前闪光。2001年11月，他出现严重神经系统症状，包括意识混乱、空间定向力下降。脑MRI见Figure 3。脑脊液除了蛋白水平高（1.7g/l）外，其他正常，脑脊液OB阴性。给予全身皮质激素（1g/d静脉滴入*7d，然后改为口服），后患者症状好转。2002年1月，症状复发，包括思睡、意识混乱、定向力障碍、认知、记忆障碍、共济失调。血Rt、C反应蛋白、凝血相、感染及免疫系统相关检查未见异常。复查MR结果和上次类似。因为听力下降，行听力检测提示双耳感觉神经性耳聋。检测视力正常，眼底检测显示多发视网膜分支动脉闭塞。视野检查提示双眼多处视野缺损。继续激素、环磷酰胺治疗、血浆置换治疗。患者症状很快好转。2002年6月，再次复发，继续上述治疗，好转。到现在患者未在此发作。Spdc战友： 多发性硬化。患者发病在时间上有多次发作，病变部位以脑白质为主，主要分布于侧脑室周围。临床表现有高级皮层受损、视觉、听觉受损。脑脊液蛋白升高，激素和其他抗免疫治疗有效。这些都是多发性硬化的特点。Xuehai905战友： 我考虑多发性硬化。诊断依据：1。年龄小于50岁，慢性病程。2。病程中有复发缓解,3次复发，逐渐积累使病 情加重；3。有多发性硬化典型症状和体征，如头痛，视力障碍，共济失调，精神障碍，认知功能障碍等。4.有时间上和空间上离散性病灶的证据。5。磁共振表现侧脑室周围，半卵圆中心等可见类圆形或融合性斑块。 Y请注意“检测视力正常，眼底检测显示多发视网膜分支动脉闭塞”。 公布答案：SUSAC综合症国外病例报道Case 1The first case was already described as a brief report in 2001 in his acute presentation,2 with presently more than 6 years of followup.A 35-year-old man presented in February 1998 with a loss ofhis left inferior hemifield. Retinal arterial occlusion was diagnosed.Three months later, he developed a sudden right hearing loss withtinnitus related to a sensorineural hypoacousia. Partial improvement was obtained after systemic corticosteroids treatment. In August 1998, he had headaches and a few days later, he presented with an acute encephalopathy with cognitive changes, confusion,and memory and psychiatric disturbances. Brain MRI showed, on T2 weighted images, multifocal hyperintense lesions in the white matter, especially in the corpus callosus (central part) and in the right cerebellar peduncle. Multiple sclerosis was retained as first diagnosis. Blood tests, including blood count, C-reactive protein,coagulation profile, and serology for infective agents were normal.Cerebrospinal fluid (CSF) protein levels were normal (0.34 g/L).No oligoclonal bands were detected in CSF. On ophthalmologic examination, visual acuity was 20/20 in both eyes. However, visual fields showed multiple defects (Figure 1), which were correlated with the multiple retinal art