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Neurological Emergencies - part 10

Nhiều loại thuốc đã được thử nghiệm bao gồm các thuốc chống đông máu, tiểu mộng của tiêm các thuốc giãn mạch, noradrenaline tiêm tĩnh mạch (norepinephrine), các đại lý tan huyết khối, và các corticosteroid. Johnson et al.92 báo cáo rằng một sự kết hợp của levodopa và carbidopa | NEUROLOGICAL EMERGENCIES to date no therapy is of significant benefit. Numerous drugs have been tried including anticoagulants sub-Tenon s injections of vasodilators intravenous noradrenaline norepinephrine thrombolytic agents and corticosteroids. Johnson et al.92 reported that a combination of levodopa and carbidopa Sinemet prompted visual recovery in patients with non-arteritic AION of more than six months duration. These results have not been confirmed. Haemodilution has also been described as improving visual function in longstanding non-arteritic AION93 and in AION of less than two weeks duration when combined with pentoxifylline.94 Further verification of this potentially beneficial treatment is required. Direct surgical intervention by optic nerve sheath decompression has been shown in a multicentred randomised trial to be ineffective and possibly visually harmful.57 This type of surgery is no longer used in the United States. The emergency treatment of choice in giant cell arteritis-associated AION or PION is high dose prednisone 60-80 mg per day pending a temporal artery biopsy. Because of the risk to the second eye this treatment is also recommended in suspected cases of giant cell arteritis in spite of a normal ESR or fibrinogen level. Corticosteroids in non-arteritic ischaemic optic neuropathy are of questionable value although they are frequently used when the second eye becomes involved. Embolic ischaemic optic neuropathy when symptomatic of ipsilateral ICA disease should be managed according to the severity of the carotid artery disease. For additional guidance with regard to the management of retinal embolic disease see Branch retinal artery occlusion the section Emergency treatment . Prognosis The prognosis for recovery of vision is poor particularly in patients with the arteritic form of ischaemic optic neuropathy. The long term clinical course in non-arteritic ischaemic optic neuropathy is not well documented. In one follow up study of 205 .