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目的分析首诊于神经眼科的血液系统肿瘤患者的临床及影像学特征。设计回顾性病例系列。研究对象2015年解放军总医院神经眼科诊治的3例以视神经病变为首发表现,最终病理确诊为血液系统肿瘤患者。方法回顾性分析患者的临床、影像、实验室检查及病理结果。主要指标临床表现、眼眶磁共振成像(MRI)、血液及脑脊液检测、骨髓及脑组织病理检查。结果3例患者年龄均>50岁,其中2例首发症状为视力下降,1例双眼一过性黑矇为首发症状。病理类型分别为弥漫大B细胞淋巴瘤、小B细胞型淋巴瘤、多发性骨髓瘤。眼眶MRI检查:2例淋巴瘤患者可见视神经增粗,伴不同程度强化;多发性骨髓瘤患者右侧视神经及视交叉呈长T2信号,未见明显强化。结论血液系统肿瘤以视神经病变首发极为少见,临床表现为类似视神经炎症状,血液检查及影像检查有利于辅助诊断,病理检查为确诊的金标准。
Objective To analyze the clinical and radiological features of patients with hematological malignancies admitted to neuro-ophthalmology. Design retrospective case series. Subjects Three cases of neuro-ophthalmologic diagnosis and treatment of PLA General Hospital in 2015 were made with optic neuropathy as the first manifestation, and the final pathology was diagnosed as hematological malignancies. Methods Retrospective analysis of patients with clinical, imaging, laboratory tests and pathological results. The main indicators of clinical manifestations, orbital magnetic resonance imaging (MRI), blood and cerebrospinal fluid testing, bone marrow and brain tissue pathology. Results All the 3 patients were over 50 years old. The first symptom of 2 cases was visual acuity decrease, and the other 1 case had transient dark mammography as the first symptom. Pathological types were diffuse large B cell lymphoma, small B cell lymphoma, multiple myeloma. Orbital MRI: Two cases of lymphoma showed optic nerve thickening, with varying degrees of enhancement; multiple myeloma patients with right optic nerve and optic chiasm were long T2 signal, no significant enhancement. Conclusion The hematological malignancies are very rare with optic neuropathy. Their clinical manifestations are similar to the symptoms of optic neuritis. Blood tests and imaging are helpful to diagnose and pathologically confirm the gold standard.