肝性皮质盲12例临床分析

摘要

Objective To explore the clinical characteristics, pathogenesis and treatment options of hepatic cortical blindness(HCB).Methods The predisposing factors, clinical characteristics, treatment and outcomes of 12 patients with Hepatic cortical blindness were analysed. Results All cases suffered from severe hepatitis or liver cirrhosis, with a morbidity rate of 2.05％. The predisposing factors included fatigue, gastrointestinal bleeding, high-protein diet and improper medication, etc. The clinical characteristics included temporary blindness, possibly associated with consciousness disturbance in various degrees, no-response by twinkling of eyes under strong light irradiation or external terrifying stimulation, equal sizes of opposite pupils, normal reflex to light; and no organic disease detected in fundus, visual paths or intracalvarium. Active treatments for the hepatic encephalopathy improved all of patients' health state. Conclusion The incidence of hepatic cortical blindness is Iow and it is fairly rare in clinical work. It is easy to be missed diagnose or misdiagnosed. It can be considered as one of the special symptoms of hepatic encephalopathy.%目的 探讨肝性皮质盲的临床特点、发病机制及诊治措施.方法 对12例肝性皮质盲患者的发病诱因、临床特点、治疗及转归加以分析.结果 12例肝性皮质盲均在重型肝炎或肝硬化基础上发生,其发病率2.05%,起病前多有劳累、消化道出血、高蛋白饮食、不当应用药物等诱因;临床以一过性视觉丧失,可伴有不同程度意识障碍,强光照射及外界恐吓性刺激时眼睛无闭合反应,双侧瞳孔大小相等、对光反应存在,眼底、视觉通路及颅内无器质性病变为特征;积极治疗肝性脑病可100%好转.结论 肝性皮质盲发病率低,临床较为罕见,易于漏诊或误诊,一旦罹发,可视为肝性脑病的特殊表现之一.