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目的:报告免疫力正常少年的隐球菌脑膜炎1例,早期表现为复视和双眼视力低下。方法:病例报告。结果:男,17岁,两眼视物模糊并复视3wk,伴随严重的搏动性头痛、恶心、呕吐及低热。经体格检查无发热及假性脑膜炎迹象。双眼视力为6/15并视野缩窄。双眼前段正常。眼外肌运动表明双侧第六神经麻痹。眼底检查显示双侧视盘充血和轻度隆起。CT扫描大脑正常,无颅内肿块或脑室异常。腰椎穿刺发现高开放压>300mmH2O。脑脊液显微镜下及培养均存在新型隐球菌。本例由神经医疗组联合处理。患者开始静脉注射两性霉素B和氟康唑,神经症状1wk后恢复,双眼视力提高到6/6,同时周边视野恢复。随着第六神经麻痹的康复双眼复视得到好转。结论:本例强调了隐球菌脑膜炎进展缓慢的性质。即使免疫功能正常,也不会存在明显的假性脑膜炎特征,复视可能是脑膜炎患者的早期表现之一。
OBJECTIVE: To report a case of cryptococcal meningitis in children with normal immunity, early manifestations of diplopia and binocular vision loss. Methods: Case report. Results: Male, 17 years old, both eyes blurred and double vision 3wk, with severe beating headache, nausea, vomiting and fever. Physical examination without fever and signs of meningitis. Binocular visual acuity of 6/15 and narrowed field of vision. Anterior segment of both eyes normal. Extraocular muscle movement showed bilateral sixth nerve paralysis. Fundus examination showed bilateral disc hyperemia and mild uplift. Normal brain CT scan, no intracranial mass or ventricular abnormalities. Lumbar puncture found that high open pressure> 300mmH2O. Cerebrospinal fluid microscopy and culture are present Cryptococcus neoformans. This case by the neurological treatment group. Patients started intravenous amphotericin B and fluconazole, neurological symptoms recovered after 1wk, binocular vision increased to 6/6, while peripheral vision recovery. With the sixth nerve paralysis rehabilitation binocular diplopia get better. Conclusion: This example highlights the slow progression of cryptococcal meningitis. Even if the immune function is normal, there is no obvious feature of pseudomeningitis, diplopia may be one of the early manifestations of meningitis patients.