每日一题_2024.02.01

A 44-year-old man presented to the emergency department with a 3-day history of vision loss and pain in the left eye. The symptoms had started after he had passed out for 3 hours in a position that put pressure on his left eye; before losing consciousness, he had taken insomnia medications and consumed alcohol. An anterior segment examination showed hemorrhagic chemosis and a fixed, mid-dilated pupil (left). The intraocular pressure in the left eye was normal. Funduscopy showed diffuse retinal whitening, a finding consistent with infarction, and optical coherence tomography revealed full-thickness retinal edema. Magnetic resonance imaging of the orbit showed engorgement of the extraocular muscles and orbital tissue (right). A diagnosis of ischemic retinopathy and choroidopathy owing to prolonged orbital compression was made. Which of the following is LEAST likely to be found on physical examination in this patient?

一名44岁男性因视力下降和左眼疼痛3日到急诊科就诊。这些症状是在他昏倒3小时后出现的，昏倒的姿势压迫了他的左眼;在失去意识之前，他曾服用失眠药物并饮酒。眼前节检查显示出血性结膜水肿和瞳孔固定、中度散大(左)。左眼的眼压正常。眼底检查显示弥漫性视网膜白斑，这一发现与梗死相符，光学相干断层扫描显示全层视网膜水肿。眼眶磁共振成像显示眼外肌和眼眶组织充血(右)。诊断为长时间眼眶压迫导致的缺血性视网膜病变和脉络膜病变。在该患者的体格检查中最不可能发现下列哪一项?

A. Absence of light perception in the left eye 左眼无光感

B. A relative afferent pupillary defect 相对传入性瞳孔缺陷

C. Complete ophthalmoplegia of the left eye 左眼完全眼肌麻痹

D. Proptosis 突出

E. Vertical nystagmus 垂直眼震

答案解析：

正确答案是垂直眼震；所有列出的其他表现均在该患者中观察到。历史上，这种情况被称为“周六夜间视网膜病变”，因为它与使用酒精和镇静剂有关。目前对该病的治疗尚未达成共识。患者接受了全身大剂量糖皮质激素和局部药物治疗，以防止眼压升高;然而，在初次评估后4个月的电话随访中，患者自诉左眼仍然失明。

正确答案：E