枕叶脑梗死患者临床特点及视野分析

Clinical characteristics and visual field in patients with occipital lobe infarction

目的分析以眼部症状为主的脑梗死患者的病因、临床症状、视野及视野转归等,探讨枕叶脑梗死后同向偏盲的康复预后,以减少脑梗死在眼科的漏诊、误诊。方法回顾性分析2003年3月至2011年11月我院48例脑梗死患者的病因、临床症状、视野检查及视野转归等结果,分析其发生机制,推测视野缺损程度与脑梗死预后的关系。结果 48例患者中31例因主诉视物模糊、1例突然双眼失明而首诊于眼科。视力下降23例,视野缺损42例(完全性同向偏盲35例,其中伴黄斑回避20例;象限缺损7例,其中伴黄斑回避4例),短暂性视力障碍4例,双眼失明1例,复视7例,闪光幻视1例,上睑下垂2例。伴随症状有头晕、头痛、恶心、共济失调、肢体麻木、语言障碍等。48例中双侧枕叶脑梗死1例,单纯枕叶脑梗死25例,枕叶合并1个病灶15例(枕颞叶8例,枕顶叶2例,枕叶合并丘脑5例),枕叶合并2个以上病灶者7例(枕额顶叶1例,枕顶颞叶2例,多发梗死灶4例)。结论枕叶脑梗死可首先出现以视物模糊、视力下降及视野缺损为主的眼部症状,部分患者可首诊于眼科。枕叶脑梗死视野缺损以同向性偏盲为主,包括完全性同向偏盲、不完全性同向偏盲等。眼科医师应注意检查患者眼底、视野及颅脑CT或MAI检查,以明确诊断,减少误诊、漏诊。

Objective To analyze the causes, clinical symptom, eyesight and eyeshot prognosis of the cerebral infarction patients with ocular symptoms, explore the rehabilitation prognosis of homonymous hemianopia after occipital lobe infarction, and reduce the missed diagnosis and misdiagnosis of cerebral infarction in ophthalmology. Methods The clinical symptoms, etiology, perimetry and eyeshot outcome of 48 patients with cerebral infarction in our hospital from March, 2003 to November, 2011 were retrospectively analyzed. The relationship between the defect severity of visual field and prognosis of cerebral infarction was speculated by analyzing its mechanism. Resuits The ophthalmology were initially visited by 31 patients with complaint of vision blurring and 1 patient with sudden blindness of both eyes. Vision loss occurred in 23, visual field defects in 42 （20 of macula-sparing in 35 of complete homonymous hemianopsia, and 4 of macula-sparing in 7 of quadrant defect）, transient visual disorder in 4, totally blind in 1, diplopia in 7, spintheropia in 1, and eyelid ptosis in 2. Simultaneous phenomenon included dizziness, headache, nausea, limb numbness, ataxia, and speech impediment. There were 1 of bilateral occipital lobe cerebral infarction, 25 of mere occipital lobe infarction, 15 of occipital lobe lesion combined with another 1 lesion （8 in temporal lobe,2 in parietal lobe, and 5 in thalamus）, and 7 of occipital lobe lesion with other 2 or more lesions （ 1 in frontoparietal lobe, 2 in temporoparietal lobe, and 4 with multi-infarction lesions）. Conclusion Sight blur, vision loss and visual defects may first appear in patients with occipital lobe infarction, so some patients can be diagnosed in ophthalmology. Visual defects in occipital lobe infarction mainly show homonymous hemianopia, including complete homonymous hemianopsia, incomplete partial blindness and so on. Ophthalmologists should check out patients＇ eyes, vision and brain CT or MRI to co-firm diagnosis, reduce wrong diagnosis and avoid missing diagnosis.