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題名 | 椎動脈剝離合併皮質盲之視覺恢復:病例報告=Visual Restoration in Vertebral Artery Dissection with Cortical Blindness: A Case Report |
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作者 | 林彣芷; 陳怡如; 陳品秀; 蕭珮琦; 蘇炯睿; 劉榮泰; 周偉倪; | 書刊名 | 臺灣復健醫學雜誌 |
卷期 | 42:3 2014.09[民103.09] |
頁次 | 頁171-176 |
分類號 | 415.92 |
關鍵詞 | 椎動脈剝離; 視覺恢復; 皮質盲; Vertebral artery dissection; Visual restoration; Cortical blindness; |
語文 | 中文(Chinese) |
中文摘要 | 椎動脈剝離(vertebral artery dissection)的發生率約為十萬分之一,臨床症狀多變,常以眩暈、頭痛、耳痛或頸痛為初始症狀,其中四分之一會發生後顱窩循環型中風(posterior circulation stroke),是年輕型中風最常見的原因之一。後顱窩循環型中風,視覺相關症狀以視力模糊最常見,其次為複視,視力完全喪失並不常見。本篇報告一位34歲女性,因椎動脈剝離致後顱窩循環型中風,於發病初期呈現完全皮質盲(complete cortical blindness)之狀態,同時有運動與感覺機能受損。約在中風兩個月後開始有視覺恢復:先對光線有反應、之後能辨別形狀、最後能辨別顏色。病人因視力障礙,對人、事、時與地等的定向出現困難,同時睡眠周期紊亂。因此,對於此類中風病人除了肢體功能復健之外,還需加強神經視覺復健(neurovisual rehabilitation),如增加光源、移除障礙物、或增加色彩對比性等環境改造,亦可利用視力輔助器盡量提高病人之視覺能力,以增加復健治療之效果。本報告針對椎動脈剝離的臨床表現及皮質盲之神經視覺復健進行文獻回顧與探討,提供日後臨床醫師診療參考之用。 |
英文摘要 | The annual incidence of vertebral artery dissection is 1 in 100,000. The clinical manifestations are diverse, including dizziness, occipital headache, neck pain and posterior circulation ischemia. One fourth of patients with vertebral artery dissection develop posterior circulation stroke, so vertebral artery dissection is considered one of the common causes of young stroke. The most common ophthalmic signs after posterior circulation ischemia are blurry vision followed by diplopia, whereas complete visual loss is uncommon. This report describes a 34-year-old woman who presented with complete cortical blindness caused by spontaneous vertebral artery dissection with ischemic stroke in the posterior circulation. In addition to visual problems, she also had motor and sensory deficits. Her visual recovery began 2 months after stroke, in the sequence of light perception, shape distinction, followed by color discrimination. Due to visual impairment, she also had disorientation and sleep disturbance. Therefore, visual rehabilitation such as lighting conditioning, contrast enhancement, and optical aids are important and should be applied to this kind of patients. The clinical manifestations of vertebral artery dissection and the treatment of bilateral cortical blindness are discussed in this report, and relevant literature is reviewed. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。