新型隐球菌性脑膜炎的眼部临床表现分析

Analysis of clinical manifestation of the eyes with cryptococcal neoformans meningitis

目的:分析新型隐球菌性脑膜炎患者的眼部临床特征。方法:回顾性分析经病原学确诊的新型隐球菌性脑膜炎患者20例的眼部病变特点以及颅内压与视盘水肿的关系。结果:20例患者中主诉中出现视物模糊者4例占20%;出现视盘水肿的9例占45%;眼球活动受限6例占30%;另外有2例患者出现单眼视神经萎缩占10%;1例出现瞳孔对光反射迟钝占5%。就诊时颅内压高组有7例出现视盘水肿占47%,颅内压正常组有2例出现视盘水肿占40%,两者无显著性差异。结论:新型隐球菌性脑膜炎患者中有90%出现了眼部症状。双眼视物模糊、视盘水肿是最常见的表现。新型隐球菌性脑膜炎患者病情迁延反复,视盘水肿并不能随着颅内压的降低迅速消退,严重者可能导致视神经萎缩。对由新型隐球菌性脑膜炎引起的视盘水肿应该积极治疗。

AIM： To investigate the ocular clinical characteristics patients with cryptococcal neoformans meningitis （CNM）.METHODS： Ocular manifestations and the relationship between intracranial pressure and papilledema were analyzed retrospectively in 20 patients diagnosed as CNM by etiology.RESULTS： Among 20 patients, 4（20%） had blurred vision in their thief complains, 9 （45%） patients had papilledema, 6 （30%） patients had restrained ocular movement. Optic nerve atrophy of one eye occurred in 2 patients （10%）; 1 patient （5%） had asthenocoria to reflection of light; papilledema occurred in 2 cases （40%） and 7 cases （47%） respectively in group with normal intracranial pressure and group with intracranial hypertension. There was no statistical difference of incidence of papilledema between the group with normal intracranial pressure and the other group with intracranial hypertension. CONCLUSION： In patients with CNM, 90% have ocular symptoms. Blurred vision and papilledema are the most common symptoms in the patients with CNM. And papilledema would not be relieved rapidly with intracranial hypertension decreasing, which can lead to optic atrophy. We should understand ocular manifestations related to CNM, and give active treament to papilledema.