抗磷脂综合征表现为视乳头水肿1例

摘要

目的:报告1例罕见抗磷脂综合征的患者,由于上矢状窦血栓形成而表现为双眼视乳头水肿及右眼第六颅神经麻痹,经抗凝和乙酰唑胺治疗后视乳头水肿恢复.方法:病例报告:一44岁中国男性,主诉为头痛、复视及轻度的视物模糊.临床检查发现右眼第6神经麻痹和双眼视乳头水肿,双眼视野盲点扩大和红绿色觉缺失,计算机断层摄影及核磁共振扫描显示上矢状窦血栓形成,血液学检查证实抗磷脂综合征是其潜在原因.结果:在联合应用抗凝和口服乙酰唑胺治疗3mo后,视乳头水肿恢复至正常的解剖,扩大的视野盲点降至正常水平,双眼红绿色觉恢复正常,伴随右眼视乳头水肿消退和视力改善表明这个患者视功能得以恢复.结论:抗磷脂综合征应与视乳头水肿鉴别诊断;对于顽固性的视乳头水肿,口服乙酰唑胺是抗凝治疗的重要辅助治疗,它可以保护视神经免受有可能导致失明后果的视神经损害.%·AIM: To report a rare case of antiphospholipid syndrome presenting as papilledema and sixth nerve palsy in right eye due to superior sagittal sinus thrombosis, and regression of papilledema following anticoagulation and acetazolamide therapy.·METHODS: A 44-year-old Chinese gentleman presented with headache, diplopia and mild blurring of vision. Clinical examination revealed the presence of sixth nerve palsy in right eye and papilledema. There was enlargement of blind spot in the visual fields and red green deficiency in both eyes.Computed tomography and magnetic resonance imaging showed superior sagittal sinus thrombosis. Hematological investigation confirmed the presence of antiphospholipid syndrome as the underlying cause.·RESULTS: The condition was treated successfully in three months with the adjunctive use of anticoagulation and acetazolamide. Reversal of papilledema changes in the optic disc to normal indicates the anatomical recovery, while reduction of enlargement of blind spot to normal size,recovery of red green deficieny to normal colour vision in both eyes and visual improvement after regression of papilledema in right eye indicate functional recovery in this patient.·CONCLUSION: Antiphospholipid syndrome should be considered in the differential diagnosis of papilledema, and oral acetazolamide is an important adjunct therapy to anticoagulation in cases of refractory papilledema to protect the optic nerve from potential damage which results in blindness.