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目的:报告罕见的儿童早期复发型视神经脊髓炎的成功治疗1例。方法:病例报告。结果:患者,女,8岁,卡达山族,突发性双眼视力下降5d后,出现左下肢肌力减弱症状。发病时,患者双眼视力为光感,伴双眼视盘充血水肿。脑部与脊髓MRI显示:右额叶及颈5水平脊髓后部有白色增强信号的病变,诊断为视神经脊髓炎,给予静脉注射甲基强的松龙冲击治疗,随后转为口服泼尼松龙维持治疗。1mo后症状逐渐缓解。然而,停止口服泼尼松龙1wk后症状复发。复查脑脊髓MRI显示:在脑部的同样区域以及脊髓颈3到颈5段仍有持续的炎症存在,遂立即给予甲基强的松龙冲击治疗,并口服激素延缓减量。2mo后,患者已经可以行走并参与学校活动,此时双眼的视力提高到0.6,但还残留少量的色觉损害,下肢神经检查也正常。口服递减药量的泼尼松龙维持治疗持续4mo,随访1a没有复发。最终,患者视力恢复到右眼0.8,左眼0.6。结论:对于突发性双眼视力下降伴随肢体肌力减弱的儿童患者,必须对视神经脊髓炎有所警惕。早期诊断及治疗有利于患者的康复。
AIM: To report a rare case of successful treatment of early childhood recurrent optic neuromyelitis in children. Methods: Case report. Results: The patient, female, 8 years old, Cada Mountain, sudden bilateral binocular vision decreased 5d, left lower extremity muscle weakness symptoms. Occurrence, the patient’s binocular vision for light perception, with binocular optic disc congestion and edema. MRI of the brain and spinal cord showed lesions of the white-enhanced signal at the posterior portion of the right frontal lobe and the cervical 5-level spinal cord, diagnosis of optic neuromyelitis, intravenous methylprednisolone impact treatment, and subsequent conversion to oral prednisolone Maintenance treatment. After 1mo symptoms gradually eased. However, stopping the oral prednisolone 1wk after the recurrence of symptoms. Review of cerebrospinal fluid MRI showed: in the same area of the brain and spinal cord neck 3 to 5 still have persistent inflammation, was immediately given methylprednisolone impact treatment, and oral administration of hormones delay reduction. After 2 months, the patient was able to walk and participate in school activities. At this time, the eyesight of both eyes was raised to 0.6, but a small amount of color vision remained and the lower extremity nerve examination was normal. Prednisolone maintenance therapy continued for 4 months with decreasing dose of oral prednisolone and did not recur after follow-up. Finally, the patient’s visual acuity returned to the right eye 0.8, left eye 0.6. Conclusion: For children with sudden decline of binocular visual acuity accompanied by weakened limb muscle strength, vigilance against optic neuromyelitis must be observed. Early diagnosis and treatment are beneficial to the patient’s recovery.