tailieunhanh - Báo cáo y học: " Unilateral optic neuropathy following subdural hematoma: a case report"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Unilateral optic neuropathy following subdural hematoma: a case report | Kretz et al. Journal of Medical Case Reports 2010 4 19 http content 4 1 19 jAg JOURNALOF medical ÌỤr case REPORTS CASE REPORT Open Access Unilateral optic neuropathy following subdural hematoma a case report Alexandra Kretz1 Christoph Preul1 Hans-Joerg Fricke2 Otto W Witte1 Christoph Terborg3 Abstract Introduction Unilateral optic neuropathy is commonly due to a prechiasmatic affliction of the anterior visual pathway while losses in visual hemifields result from the damage to brain hemispheres. Here we report the unusual case of a patient who suffered from acute optic neuropathy following hemispherical subdural hematoma. Although confirmed up to now only through necropsy studies our case strongly suggests a local microcirculatory deficit identified through magnetic resonance imaging in vivo. Case presentation A 70-year-old Caucasian German who developed a massive left hemispheric subdural hematoma under oral anticoagulation presented with acute severe visual impairment on his left eye which was noticed after surgical decompression. Neurologic and ophthalmologic examinations indicated sinistral optic neuropathy with visual acuity reduced nearly to amaurosis. Ocular pathology such as vitreous body hemorrhage papilledema and central retinal artery occlusion were excluded. An orbital lesion was ruled out by means of orbital magnetic resonance imaging. However cerebral diffusion-weighted imaging and T2 maps of magnetic resonance imaging revealed a circumscribed ischemic lesion within the edematous slightly herniated temporomesial lobe within the immediate vicinity of the affected optic nerve. Thus the clinical course and morphologic magnetic resonance imaging findings suggest the occurrence of pressure-induced posterior ischemic optic neuropathy due to microcirculatory compromise. Conclusion Although lesions of the second cranial nerve following subdural hematoma have been reported individually their pathogenesis was preferentially proposed .