Traumatic chiasmopathy following mild trauma in a patient with thyroid orbitopathy.
Traumatic chiasmopathy following mild trauma in a patient with thyroid orbitopathy.
复制标题
甲状腺眼眶病患者轻度创伤后的创伤性交叉病变。
DOI：
10.1016/j.ajoc.2021.101021
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发表时间：
2021-03
影响因子：
--
通讯作者：
Gospe SM 3rd
中科院分区：
文献类型：
--
作者：
O'Sullivan ML;Gospe SM 3rd
视交叉的创伤性损伤是罕见的，最常见的是由高速头部创伤引起的。它的典型结果是双颞偏盲，并经常与多种其他创伤性损伤，如颅骨骨折和脑脊液漏一起出现。我们报告一位40岁的女性，先前就有甲状腺眼眶病变，在从站立高度跌倒后撞到前额。该患者因创伤性视神经病变和可能的视神经撕脱而立即发生严重的单侧视力丧失。光学相干断层扫描显示对侧眼出现颞侧偏盲，伴有视网膜神经纤维层延迟和鼻侧半斑神经节细胞层变薄，与视交叉病理学一致。磁共振成像显示，在视交叉或沿沿着传入视觉通路更靠后的位置没有明确的病变。这个病人的严重视力丧失提示甲状腺眼眶病引起的眼球突出会使前部视觉通路对创伤敏感。在这种情况下，我们提出，缺乏松弛的眶内视神经允许传输的拉伸力的视交叉在设置低速钝伤。
Traumatic injury to the optic chiasm is rare and most frequently caused by high-velocity head trauma. It classically results in bitemporal hemianopsia and often presents in conjunction with multiple other traumatic injuries, such as skull fractures and cerebrospinal fluid leaks. We present the case of a 40-year-old woman with pre-existing thyroid orbitopathy who struck her forehead after a fall from standing height. This patient suffered immediate profound unilateral vision loss from traumatic optic neuropathy and possible optic nerve avulsion. The fellow eye manifested a temporal hemianopsia with delayed retinal nerve fiber layer and nasal hemimacular ganglion cell layer thinning on optical coherence tomography, consistent with chiasmal pathology. Magnetic resonance imaging showed no definitive lesions at the optic chiasm or more posteriorly along the afferent visual pathway. This patient's severe vision loss suggests that proptosis from thyroid orbitopathy can sensitize the anterior visual pathway to trauma. In this case, we propose that the lack of laxity in the intra-orbital optic nerves allowed transmission of stretching forces to the optic chiasm in the setting of low-velocity blunt trauma.