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目的观察视神经撕脱伤的影像学表现和视觉电生理特征,作为早期诊断的依据。方法视神经撕脱的早期因出血无法窥及眼底,建议以影像学及视觉电生理特征结合临床表现进行诊断,并举出临床所遇6例以资印证。结果视神经撕脱临床上主要特征有视力严重下降、相对性瞳孔传入障碍、视盘出血和玻璃体积血。本组2例完全性视神经撕脱及4例部分视神经撕脱均表现为:CT显示前段视神经增粗,可伴有巩膜后不均匀高密度影,出现视盘前丘状或扁平高密度影;B超可见视盘前或视盘边缘扁平或丘状隆起,伴有玻璃体积血者可有玻璃体腔内大量中强回声;视觉电生理表现为视网膜电图(ERG)的a或b波波幅降低并伴有视诱发电位(VEP)的潜伏期延迟及波幅降低;部分撕脱者可表现为ERG正常或伴有a或b波波幅降低,伴或不伴VEP潜伏期延迟和波幅降低。结论视神经撕脱伤早期无法视及眼底的病例可根据影像学和视觉电生理检查结果结合临床表现定诊断。
Objective To observe the imaging findings and visual electrophysiological characteristics of optic nerve avulsion injury as the basis for early diagnosis. Methods The early avulsion of the optic nerve can not peep at the fundus due to bleeding. It is suggested to diagnose with the combination of imaging and visual electrophysiological characteristics with clinical manifestations, and give examples of 6 cases clinically encountered. Results The major clinical features of optic nerve avulsion were severe vision loss, relative pupillary afferent disorder, optic disc hemorrhage and vitreous hemorrhage. The two cases of complete avulsion of the optic nerve and 4 cases of partial optic nerve avulsion are manifested as: CT showed anterior optic nerve thickening, may be associated with uneven high-density scleral shadow, anterior optic disc or flat high-density shadow; B Ultra-visible optic disc or optic disc edge flat or mound bulge, accompanied by vitreous hemorrhage may have a large number of moderate intravitreal echo; visual electrophysiology showed electroretinogram (ERG) a or b wave amplitude decreased and accompanied by Latency latency and amplitude decrease of VEP were observed. Some patients with partial avulsion showed normal or accompanied ERG a or b wave amplitude with or without VEP latency delay and amplitude decrease. Conclusions In the early stage of optic nerve avulsion injury, cases of inoperable and fundus diseases can be diagnosed according to the results of imaging and visual electrophysiological examination combined with clinical manifestations.