Neurology病例:神经节细胞模式定位前视觉通路病变

2022-08-11 神经科病例撷英拾粹 神经科病例撷英拾粹

神经节细胞模式定位前视觉通路病变病例分享。

在垂体肿瘤压迫视神经交叉的管理中,通过光学相干断层扫描测量视网膜神经节细胞层厚度可为前视觉通路病变提供客观和可靠的评估,以补充视野检查。我们展示3种不同的神经节细胞层变薄模式——交界(图1A-D)、双鼻侧(图1B和E)和同侧(图1C和F)——并说明这些模式如何对应于垂体腺瘤压迫视交叉的位置,前部(图2A)、中央(图2B)或后部(图2C)。考虑神经节细胞层变薄的模式,结合视野检查,有助于前视觉通路病变部位的预测。

(图1:T2WI[D]上可见垂体腺瘤[红箭]压迫前部视交叉,对应于同侧眼的弥漫性视野丧失[暗区],对侧眼上颞侧交界性暗点[A]以及光学相干断层扫描[D]上同侧眼弥漫性神经节细胞变薄[蓝区]和对侧眼下鼻侧变薄;中央压迫对应于双颞侧偏盲[B]和双鼻侧神经节细胞变薄[E];后部压迫对应于[不一致的]对侧同向偏盲[C]以及同侧眼颞侧神经节细胞变薄和对侧眼鼻侧变薄[F])

(图2:A:垂体腺瘤[粉红色]累及右侧视神经和左侧下内侧视神经[黑箭]压迫前部视交叉[灰色];B:垂体腺瘤压迫中央视交叉;C:垂体腺瘤累及左侧视束压迫后部视交叉)

[参考文献]

Miller GD, Vuong LN, Hedges TR 3rd. Teaching NeuroImage: Ganglion Cell Patterns Localize Anterior Visual Pathway Lesions. Neurology. 2021 Oct 19;97(16):e1637-e1638. 

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    2023-05-06 yinhl1978
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    2022-08-06 zywlvao

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