视神经视网膜炎合并Bell麻痹

摘要

目的 报道1例罕见的视神经视网膜炎合并Bell麻痹.方法 病例报道.结果 男孩16岁,右眼视物模糊1wk就诊,伴高热以及两侧面部不对称.视力右眼0.1(6/60),左眼1.0(6/6).右眼眼底表现为视盘充血水肿及黄斑部存在星芒状皱褶.左侧下运动神经麻痹,Humphrey视野检查表现为旁中心暗点和生理盲点扩大.全血细胞记数显示中性粒细胞增多及血沉加快.血清学检测梅毒、弓形体病、莱姆病、猫抓病阴性.单纯疱疹、带状疱疹、艾滋病毒检测均为阴性.立克次体也为阴性,脑部及眼眶MRI均正常.未发现脱髓鞘病变.起始为甲强龙每日4次250mg静滴3d,出院后继续口服大剂量强的松1mg/kg 11d.6mo后,随访视力达1.0(6/6),视盘略显苍白,Bell麻痹也明显改善,无明显两侧面部不对称.结论 对于视神经炎,临床医生检查其他颅神经有无病变是非常重要的.视神经视网膜炎同时合并面神经麻痹非常罕见,需要进行全面的检查和问诊以排除一些重要的感染性致病原因.视神经炎合并面神经麻痹对大剂量激素治疗敏感.%AlM:To report an unusual case of neuroretinits with coexistent Bell's Palsy.METHODS:A case report.RESULTS: A 16-year-old boy presented with right eye blurring of vision for one week. It was associated with high fever and facial asymmetry. The visual acuity of the right eye was 6/60 and the left eye was 6/6. Funduscopy of the right eye showed swollen and hyperemic optic disc with presence of macular star. There was also left lower motor neuron nerve palsy. Humphrey visual field perimetry showed small paracentral scotoma with enlargement of blind spot. Complete blood count showed neutrophilia with increased erythrocyte sedimentation rate (ESR). Serology for syphilis, toxoplasmosis, Lyme disease and cat-scratch disease was negative. Herpes simplex virus, Herpes zoster virus, and human immunodeficiency virus investigations were negative. Rickettsia was also negative. MRI of the brain and orbit were normal without demyelinating lesion. He was started with high dose intravenous methylprednisolone 250mg four times per day for three days. He was then discharged home with oral prednisolone 1mg/kg for another 11 days. During the follow-up,the visual acuity was improved to 6/6 after six months with slightly pale disc.The Bell's palsy was also improved without obvious facial asymmetry.CONCLUSION:It is important for clinician to examine other cranial nerces in optic neuritis. Although neuroretinitis with coexistent facial nerve in optic neuritis.Although neuroretinitis with coexistent facial nerve palsy is a rare conditon,thorough examinations and investigations should be made to exclude the inportant infetice causes.Optic neuritis with coexistent facial nerce palsy responds well to the high dose steroids.