Utility of lumbar puncture in diagnosis of Vogt-Koyanagi-Harada disease
Utility of lumbar puncture in diagnosis of Vogt-Koyanagi-Harada disease
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DOI：
10.1007/s10792-007-9044-y
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发表时间：
2007-06-01
影响因子：
1.6
通讯作者：
Rao, Narsing A.
中科院分区：
文献类型：
--
作者：
Tsai, Julie H.;Sukavatcharin, Somsiri;Rao, Narsing A.
目的探讨腰椎穿刺在诊断Vogt-Koyanagi-Harada病(VKH)中的意义。方法对连续诊断的116例VKH患者进行回顾性分析。分析中还包括另外两名患有急性 VKH 的患者。从病历中提取人口统计特征，包括性别、年龄和种族。记录就诊时的疾病阶段。收集了有助于诊断 VKH 的相关实验室结果和诊断程序，如腰椎穿刺、荧光素血管造影和超声造影。结果 获得了 10 名患者的腰椎穿刺结果。其中 8 名患者出现细胞增多，符合 VKH 的诊断。临床特征和荧光素血管造影证实了这些患者的诊断。两名未表现出脑脊液（CSF）细胞增多的患者均出现头痛、视力丧失和双侧葡萄膜炎。荧光素血管造影显示视网膜色素上皮水平存在多个渗漏病灶，并伴有视网膜下染料积聚和椎间盘渗漏，证实了 VKH 的诊断。结论 鉴于临床特征和荧光素血管造影本身通常支持诊断，因此应重新评估腰椎穿刺作为 VKH 诊断标准的效用。与手术相关的固有风险和并发症必须促使临床医生保留对非典型表现的评估。
Purpose To determine the significance of lumbar puncture in diagnosis of Vogt-Koyanagi-Harada disease (VKH).Method A retrospective analysis was conducted on 116 consecutive patients diagnosed with VKH. Two additional patients who presented with acute VKH were included in the analysis. Demographic characteristics, including gender, age, and ethnicity, were extracted from the medical record. The stage of disease at presentation was documented. Pertinent laboratory results and diagnostic procedures such as lumbar puncture, fluorescein angiography, and echography that contributed to the diagnosis of VKH were collected.Results Lumbar puncture results for 10 patients were available. Eight of these patients presented with pleocytosis consistent with a diagnosis of VKH. Clinical features and fluorescein angiography confirmed the diagnosis in these patients. Both of the patients who did not exhibit cerebrospinal fluid (CSF) pleocytosis presented with headache, vision loss, and bilateral uveitis. Fluorescein angiography disclosed multiple foci of leakage at the retinal pigment epithelium level with accumulation of dye under the retina and disc leakage, confirming diagnosis of VKH.Conclusions The utility of lumbar puncture as a diagnostic criterion for VKH should be re-evaluated given that clinical features and fluorescein angiography alone often support the diagnosis. The inherent risks and complications associated with the procedure must prompt the clinician to reserve this evaluation for atypical presentations.