Bilateral paraneoplastic optic neuropathy and unilateral retinal compromise in association with prostate cancer: a differential diagnostic challenge in a patient with unexplained visual loss.
Bilateral paraneoplastic optic neuropathy and unilateral retinal compromise in association with prostate cancer: a differential diagnostic challenge in a patient with unexplained visual loss.
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与前列腺癌相关的双侧副肿瘤性视神经病变和单侧视网膜损害：对不明原因视力丧失患者的鉴别诊断挑战。
DOI：
10.1007/s10633-012-9327-0
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
Iannaccone,Alessandro
中科院分区：
文献类型：
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作者：
Carboni,Giovannella;Forma,Gina;Bond,AprilD;Adamus,Grazyna;Iannaccone,Alessandro
我们报告一位77岁的白人男性，主诉不明原因的视力丧失1年，并有4年的前列腺癌病史。进行完整的眼科检查、Goldmann视野（GVF）、静脉荧光素血管造影（IVFA）、黄斑和椎间盘光学相干断层扫描（OCT）、图形反转视觉诱发电位（PVEP）和闪光视网膜电图（ERG）。检查时，双侧视力下降。眼底检查显示视乳头改变（OS > OD），在OS中，视盘苍白，周边RPE脱落和沿拱状部的白色视网膜变色沿着。OCT正常。怀疑为癌症相关性视网膜病变（CAR）。闪光ERG为正常OD和明显降低和电阴性OS。IVFA显示双侧视网膜乳头染色和变化，高度提示视网膜中央动脉阻塞（CRAO）OS的后遗症，其中睫状视网膜动脉存在沿着乳头状黄斑束。GVF表现为双侧盲点扩大和中心盲暗点，PVEP延迟。这些发现提示癌症相关性视神经病变（CAON），通过抗视神经自身抗体（自身抗体）的存在证实。CAON是一种比CAR更不常见的副肿瘤表现，很少与前列腺癌相关。在这种极不寻常的情况下，结合视觉功能测试方法可以识别出同时存在的单侧ERG变化，这些变化最可能归因于OS中的CRAO并发症，很可能与CAON无关，并且不应与单侧CAR混淆。Auto-Ab测试结合视觉功能测试有助于更好地了解副肿瘤性视觉综合征视力丧失的病理生理学。
We report a 77-year-old Caucasian man with a 1-year complaint of unexplained visual loss and a 4-year history of prostate cancer. A complete ophthalmologic exam, Goldmann visual fields (GVFs), intravenous fluorescein angiography (IVFA), macular and disc optical coherence tomography (OCT), pattern-reversal visual evoked potentials (PVEPs), and flash electroretinograms (ERGs) were performed. On examination, visual acuity was reduced bilaterally. Fundus exam showed juxtapapillary changes (OS > OD) and, in OS, disc pallor, peripheral RPE dropout and whitish retinal discoloration along the arcades. OCTs were normal OU. Cancer-associated retinopathy (CAR) was suspected. A flash ERG was normal OD and markedly reduced and electronegative OS. An IVFA showed bilateral juxtapapillary staining and changes highly suggestive of sequelae of central retinal artery occlusion (CRAO) OS , in which a cilioretinal artery existed along the papillomacular bundle. GVFs showed bilateral blind spot enlargement and centrocecal scotomas, and PVEPs were delayed. These findings suggested cancer-associated optic neuropathy (CAON), confirmed by presence of anti-optic nerve autoantibodies (auto-Abs). No anti-retinal auto-Abs were found. CAON is a less common paraneoplastic manifestation than CAR and it is rarely observed in association with prostate cancer. A combination of visual function testing methods permitted the recognition, in this highly unusual case, of the concurrent presence of unilateral ERG changes most likely attributable to CRAO complications in OS, in all likelihood unrelated to CAON, and not to be confused with unilateral CAR. Auto-Ab testing in combination with visual function tests helps achieve a better understanding of the pathophysiology of vision loss in paraneoplastic visual syndromes.