吉兰-巴雷综合征合并视神经炎1例并文献复习

Optic neuritis in Guillain-Barrésyndrome:a case report and literature review

目的:总结吉兰-巴雷综合征(GBS)合并视神经炎患者的临床特征。方法:收集2021年12月山西医科大学第一医院神经内科收治的1例GBS合并视神经炎患者的临床资料,包括人口统计学特征、临床症状和体征、实验室和电生理数据以及眼底彩色片检查结果。对已报道的GBS合并视神经炎病例进行文献复习。结果:患者为40岁女性,因“进行性肢体麻木无力3 d”入院,通过完善肌电图、脑脊液化验等检查,结合病史、体征诊断为GBS。患者于发病后第3天开始使用免疫球蛋白治疗,第8天时肢体力量明显恢复,第12天时出现视野变暗,第19天时视力明显下降(右眼视力0.2,左眼视力0.1+1),伴有双侧视乳头水肿、视觉诱发电位潜伏期延长,诊断为视神经炎并给予糖皮质激素冲击治疗,治疗8 d后视力完全恢复,复查眼底未见异常。文献共报道GBS合并视神经炎患者28例(包括本例患者),发病年龄多集中在20~60岁,无性别倾向性。肺炎支原体是病前最常见的病原体,在10例描述了感染病原体的病例中,7例为肺炎支原体。视神经炎多累及双侧,28例患者中有21例累及双侧视神经。大多数患者GBS先于视神经炎发生或二者同时发生,28例患者中有14例GBS先于视神经炎发生,10例二者同时发生。患者对免疫治疗反应良好,20例患者视力完全恢复。结论:GBS合并视神经炎较为罕见。对GBS患者主诉视力下降要引起重视,尽早完善相关检查并给予免疫治疗。

Objective To summarize the clinical characteristics of patients with Guillain-Barrésyndrome(GBS)complicated with optic neuritis(ON).Methods The clinical data of a patient with GBS complicated with ON,who admitted to the Department of Neurology,the First Hospital of Shanxi Medical University in December 2021,were collected,including demographic characteristics,clinical symptoms and signs,laboratory and electrophysiological data,and results of fundus color films.The patients with GBS complicated with ON reported in the literature were also reviewed.Results A 40-year-old female patient with GBS was diagnosed by the results of electromyography and cerebrospinal fluid tests combining with the history and signs,who was treated with intravenous immunoglobulin on the 3rd day after onset.On the 8th day,her muscle strength improved significantly.However,on the 12th day,the visual field darkened,and on the 19th day,the vision decreased significantly(oculus dexter visual acuity 0.2,oculus sinister visual acuity 0.1+1)with bilateral papilloedema,a relative afferent pupillary defect and delayed P100 response of the visual evoked potential.Obvious abnormality was not noted in optic nerve magnetic resonance imaging.Thus ON was diagnosed and treated with pulse methylprednisolone therapy.After 8 days of treatment,the visual acuity was completely recovered and there was no abnormality in the ocular fundus.A total of 28 cases of GBS complicated with ON(including the present patient)were reported in the literature.The age of onset was mostly 20-60 years,and there was no gender preference.Mycoplasma pneumoniae was the most common premorbid pathogen and was identified in 7 of the 10 cases in which the causative agent was described.ON usually involved both sides,and 21 of 28 patients had bilateral optic nerves involved.GBS preceded ON or both occurred simultaneously in the majority of patients;GBS preceded ON in 14 of 28 patients,and both occurred simultaneously in 10 of 28 patients.All patients responded well to immunotherapy,and vision was completely recovered in 20 patients.Conclusions GBS complicated with ON is rare.Attention should be paid to the loss of vision in patients with GBS.Relevant examinations should be completed as soon as possible and immunotherapy should be given.