視覚誘発電位検査が診断および経過観察に有効であった小児視神経炎の3症例 Usefullness of VEP in children with optic neuritis

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<B>目的:</B>視覚誘発電位検査(以下VEP検査)が、診断及び経過観察に有効であった、小児視神経炎3症例を報告する。<BR><B>症例:</B>症例1:5歳女児。視力低下により、近医受診するも眼底所見に乏しく全身疾患精査のため当科紹介される。初診時視力、両眼とも(0.01)。Flash-VEPにて、著明な振幅の低下を認め球後視神経炎の診断を確定し、ステロイドパルス療法を施行した。視力回復後も経過観察を継続している。<BR>症例2:10歳女児。右眼球後視神経炎疑いにて当科紹介される。初診時視力、右(0.03)左(1.2)。ステロイドパルス療法を施行し、視力は右(1.0)と回復するが、Pattern-VEP(以下P-VEP)では、右眼の振幅低下、潜時の遅れといった著明な左右差を認め、経過観察を継続している。<BR>症例3:10歳女児。右眼視神経炎疑いにて当科紹介される。初診時視力、右(0.03)左(1.2)。P-VEPにて、右眼波形消失を認め、右眼視神経乳頭炎の診断を確定した。ステロイドパルス療法後、視力、P-VEPとも左右差を認めないまでに回復し、経過観察を終了した。<BR><B>結論:</B>視神経炎は、眼底・瞳孔反応所見等で診断が可能であるが、眼底所見に乏しく、自覚的検査に限界がある小児の球後視神経炎の場合、VEP検査を追加することで、確定診断に結びつけることができたと思われた。また、視力回復後もVEPを測定することで、自覚的検査ではわからない視神経炎後の症状を把握することができた。

<B>Purpose:</B> We describe our experiences with clinical applications of visually evoked potential (VEP) in diagnosis and follow-up of three cases of optic neuritis in the Ophthalmic Department of Aichi Children's Health and Medical Center.<BR>Purpose: To report three cases of optic neuritis in children who were diagnosed and followed up effectively by the visual evoked potential (VEP) test.<BR><B>Case 1:</B> A five-year-old girl was referred to our department due to bilateral visual impairment and inconclusive fundus examination results. The initial visual acuity was 0.01 (decimal) in both eyes. A significant decrease in amplitude revealed by the flash VEP test led to the diagnosis of bilateral optic neuritis. Subsequently, methylprednisolone pulse therapy was initiated. After gaining improved visual acuity, the patient has been followed up by several repeated VEP and visual acuity tests.<BR><B>Case 2:</B> A ten-year-old girl suspected of optic neuritis in the right eye was referred to our clinic. The initial visual acuity was (0.03) OD and (1.2) OS. Although her visual acuity recovered to (1.0) OD after methylprednisolone pulse therapy, the electrophysiological findings by Pattern-VEP indicated a significant laterality (i.e. a decrease in amplitude and delay in latency) in the right eye. She has been followed up since then.<BR><B>Case 3:</B> A ten-year-old girl suspected of optic neuritis in the right eye was referred to our clinic. The initial visual acuity was (0.03) OD and (1.2) OS. For the right eye, the Pattern-VEP examination showed a negative result indicating disappeared waveform and the diagnosis of optic neuritis was confirmed. After methylprednisolone pulse therapy, she showed excellent improvement in both visual acuity and Pattern-VEP testing and no further follow-up was necessary.<BR><B>Conclusion:</B> Although diagnosis of optic neuritis can be made based on fundus and pupil findings, the VEP testing is clinically useful for objectively testing the visual function in young children with posterior optic neuritis. In addition, the VEP testing is also helpful during follow-up to detect any subtle visual impairment caused by neurological damage from optic neuritis.

収録刊行物

  • Japanese orthoptic journal

    Japanese orthoptic journal 40, 91-97, 2011-12-26

    JAPANESE ASSOCIATION OF CERTIFIED ORTHOPTISTS

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各種コード

  • NII論文ID(NAID)
    10030281560
  • NII書誌ID(NCID)
    AN10084015
  • 本文言語コード
    JPN
  • 資料種別
    REV
  • ISSN
    03875172
  • データ提供元
    CJP書誌  J-STAGE 
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