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1、Unilateral optic neuropathy following subdural hematoma: a case report硬膜下血肿后出现的单侧视神经病变：1例病案报道Alexandra Kretz1,Christoph Preul1,Hans-Joerg Fricke2,Otto W Witte1andChristoph Terborg31Department of Neurology, University of Jena Medical School, Erlanger Allee 101, Jena D-07747, Germany2Department of Int
2、ernal Medicine, Haemato-Oncology, University of Jena Medical School, Erlanger Allee 101, Jena D-07747, Germany3Department of Neurology, Asklepios Klinik St. Georg, Lohmhlen Str. 5, Hamburg D-20099, Germanyauthor emailcorresponding author emailJournal of Medical Case Reports2010,4:19doi:10.1186/1752-
3、1947-4-19The electronic version of this article is the complete one and can be found online at:http:/ 2010 Kretz et al; licensee BioMed Central Ltd.This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http:/creativecommons.org/licenses/by/2.0), whic
4、h permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.AbstractIntroductionUnilateral optic neuropathy is commonly due to a prechiasmatic affliction of the anterior visual pathway, while losses in visual hemifields result from the damag
5、e 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 magneti
6、c resonance imagingin vivo.Case presentationA 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 ophthalmolog
7、ic 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. How
8、ever, 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 reson
9、ance imaging findings suggest the occurrence of pressure-induced posterior ischemic optic neuropathy due to microcirculatory compromise.ConclusionAlthough lesions of the second cranial nerve following subdural hematoma have been reported individually, their pathogenesis was preferentially proposed f
10、rom autopsy studies. Here we discuss a dual, pressure-induced and secondarily ischemic pathomechanism on the base ofin vivomagnetic resonance imaging diagnostics which may remain unconsidered by computed tomography.IntroductionUnilateral optic neuropathy (ON) following subdural hematoma has been con
11、firmed by necropsy studies. In these studies, microcirculatory compromise of the optic nerve was proven as a pathogenic mechanism1. In this case report, diffusion-weighted images (DWI) of magnetic resonance imaging (MRI) scans showed signal alteration in the ipsilateral optic nerve as a strong evide
12、nce for the development of microvascular deficit. Thus, our case is in line with results from autopsies. To the best of our knowledge, this is the first case presentation that demonstrates microvascular impairment with optic neuropathyin vivo.前言尸检研究已证实硬膜下血肿后可出现单侧视神经病变(optic neuropathy，ON)。这些研究证明视神经的
13、微循环损害是其致病机制 1。本例磁共振成像(magnetic resonance imaging，MRI)扫描的弥散加权成像(diffusion-weighted images，DWI)显示同侧视神经的信号发生改变，为微血管缺陷进展的有力证据，因此本病例符合尸检研究结果。据我们所知，这是首例说明体内视神经病变微血管损害的病案报道。Case presentationA 70-year-old Caucasian man of German nationality receiving warfarin therapy for the primary prevention of chronic at
14、rial fibrillation was admitted to our hospital due to symptoms of a coronary syndrome. An initial international normalized ratio (INR) of 1.7 was elevated to therapeutic ranges (INR = 2.5). Three days later, the patient was found comatose after a first-ever generalized seizure. Cerebral computed tom
15、ography (CT) revealed a subdural hematoma measuring 16 mm at its maximum thickness and covering almost the entire left convexity which caused a massive midline shift (Figure1A). Rapid cerebral MRI of the same day depicted a beginning ipsilateral uncal herniation towards the chiasmatic cistern (Figure1B). Immediately after INR normalisation, surgical evacuation of the subdural hematoma and decompressive craniectomy were performed without any complications.病情介绍一位服用华法林作为慢性房颤初级预防的70岁的男性德国籍白种人因发生冠状动脉综合征症状入住本院。 国际标准化比率(international normalized ratio， INR)由最初的1.7 升高至治疗范围(INR = 2.5)。 3天后，患者在
