神经眼科急症的诊断和治疗

Diagnosis and therapy of neuro-ophthalmological emergencies

神经眼科急症是指如果不及时诊治,就会严重威胁视力或生命的眼科临床病症,主要表现为急性视力下降、突发的复视和瞳孔不等大。一些危重神经系统疾病和眶颅炎症早期常以神经眼科急症作为首发表现。视神经炎、动脉炎性前部缺血性视神经病变、严重的眼眶炎症和感染、垂体卒中等疾病早期常出现急性视力下降;海绵窦血栓和颅内动脉瘤早期因累及颅神经而出现复视;此外,颅内动脉瘤和颈动脉夹层动脉瘤在发病初期可表现为双眼瞳孔不等大。本文从急救医学角度对上述相关疾病的症状、体征、诊断和治疗进行阐述,分析神经眼科体征在疾病诊断中的重要作用,旨在提高眼科医生对神经眼科急症的识别能力,加强危重症的防范意识。

Neuro-ophthalmological emergencies are some ocular manifestations,which are associated with the sight or life-threatening diseases if not promptly treated,including acute visual loss,sudden diplopia or anisocoria.Some severe nerve system or orbitocranial inflammatory diseases frequently present neuro-ophthalmological symptoms at the early stage.Acute visual loss is the common complaint of optic neuritis,arteritic anterior ischemic optic neuropathy,rhino-orbital-cerebral mucormycosis,and pituitary apoplexy.Diplopia usually occurs in cavernous sinus thrombosis or intracranial aneurysm because of cranial nerve palsies.Additionally,intracranial aneurysms and carotid artery dissecting aneurysm often present anisocoria initially.The clinical symptoms,signs,diagnosis and management of these disorders were reviewed from the point of emergency medicine,and the role of neuro-ophthalmological signs in the diagnosis was highlighted in this review,aiming to help ophthalmologists improve the awareness of these conditions,and emphasize the urgency of these signs.