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患者,男性,马来人,26岁,以突发左眼视神经炎首诊,给予静脉甲基强的松龙治疗,3wk后完全缓解。1wk后,两次突发右眼视神经炎,Lhermitte征和Uthoff征呈阳性。第3d,患者双侧下身瘫痪,T8水平感觉丧失,症状进行性恶化,至第5d患者卧床不起。MRI检查显示双侧视神经增宽,胸髓至腰髓、脑干及少量大脑半球可见多节段性长的脱髓鞘斑块。迅速给予静脉甲基强的松龙初始大剂量治疗,继而口服强的松龙,并且进行密切的神经理疗。3mo后患者康复,可以借助辅助行走器行走。7mo后患者完全康复,能够重新开始其网站联系人的工作。在随后的1a随访期,病情未复发,患者最终视力提高,右眼6/9,左眼6/6,右眼视野表现永久性轻度中心盲点性暗点和普遍性视敏度降低。
Patients, males and females, aged 26, were diagnosed with sudden left optic neuritis and treated with intravenous methylprednisolone, completely relieved after 3 weeks. After 1 week, bilateral sudden right optic neuritis, Lhermitte sign and Uthoff sign positive. 3d, patients with bilateral lower body paralysis, T8 level loss of feeling, progressive deterioration of symptoms, to bedridden patients on the 5th day. MRI examination showed widened bilateral optic nerve, chest marrow to the lumbar spinal cord, brain stem and a small amount of hemisphere visible multi-segmented long demyelinating plaques. Rapid intravenous methylprednisolone given initial high-dose therapy, followed by oral prednisolone, and close the nerve therapy. After 3mo patients recovered, you can walk with ancillary walker. After 7 months, the patient recovered completely and was able to resume work on his site’s contacts. During the subsequent 1-year follow-up, the disease did not recur and the patient’s final visual acuity was improved. The right eye 6/9, the left eye 6/6, the right eye field showed a permanent mild center blind spot and a generalized decrease in visual acuity.