A60-year-oldmanpresentedtoourclinicwitha6-monthhistoryofprogressivevisuallossinthelefteye.Twelvemonthsprior,heexperiencedanacutelefthemianopiasecondarytoastroke.Hewasanticoagulatedandfullyrecovered.Sixmonthsfollowingthestroke,hebegantonoticeblurredvisioninhislefteye.Therewasnoformalophthalmicexaminationperformedatthattime,butaplasticsurgeonbelievedthataleftmedialuppereyelidmasslesionwascausingdistortionofhisvision,andproceededtoexcisionbiopsy.HistopathologyrevealedRosai-Dorfmandisease(RDD).Postoperatively,thepatient’svisuallosscontinuedtoworsenandhewasreferredtoourclinic.
患者60岁男性，以“进行性左眼视力丧失6个月”为主诉就诊。12个月前，患者因脑卒中突发左侧偏盲，随后接受了抗凝治疗并完全康复。卒中后6个月，患者渐感左眼视物模糊。但患者当时没有进行正式的眼科检查，而整形外科医生认为其视物模糊是由左上眼睑内侧的肿块引起，并进行切除手术和活检。组织病理学检查提示为罗道病（Rosai-Dorfmandisease,RDD）。但术后患者的视力丧失继续恶化，遂转诊至我们诊所。
Onexamination,visualacuitywas6/6ontherightand6/12ontheleft.ThepatientcorrectlyidentifiedallIshiharacolorplateswiththerighteye,andonlythetestplateandoneotherplatewiththelefteye.Therewasalsoaleftrelativeafferentpupillarydefect.Funduscopyrevealedsubtleleftopticdiscpallor.Orbitalexaminationwasnormal.Humphreyvisualfieldofthelefteyeshowedsuperiorandinferiorarcuatedefectsandanormalrightvisualfield(figure,A).Neuroimagingrevealedadural-based,intenselyenhancingmassintheleftanteriorcranialfossa,whichhadbeendocumentedasasmallincidentalmeningioma6monthsearlier(figure,BandC).
体格检查发现：右眼视力为6/6，左眼视力为6/12；石原氏色盲测验检查提示右眼能正确识别所有色图，而左眼只能识别一块测试图和其他另一块色图；左侧相对性传入性瞳孔障碍；眼底检查可见左侧视乳头轻微苍白；眼眶检查正常；汉弗莱视野检查可见右眼视野正常，左眼上下弓形缺陷（图，A）。神经影像检查显示左侧前颅窝硬脑膜见一高信号肿块，6个月前报告为小的偶然发现的脑膜瘤（图，B和C）。
Questionsforconsideration:
1.Whatisthedifferentialdiagnosis?
2.Whatistheappropriatenextstepindiagnosticevaluation?
问题思考：
1.鉴别诊断有哪些？
2.下一步该采取哪些检查以助于诊断？
2SECTION2第二部分Thedifferentialdiagnosesforagrowingintracraniallesionthatmaymimicmeningiomaincludelymphoma,metastaticcarcinoma,Langerhanscellhistiocytosis,neurosarcoidosis,granulomatousdiseases,andneurofibromatosistype1.1Sincethepatient’svisionwasthreatenedandatissuediagnosiswasrequiredfordefinitivediagnosis,hewasreferredtoaneurosurgeonforurgentdebulkingsurgeryviaendoscopictranssphenoidalapproach.Giventhepatient’shistoryofRDDandtheexpandinglesion,intracranialRDDwassuspected.Intraoperatively,thesurgeonnotedseveredistortionoftheleftopticnervewithinferomedial北京中科医院是假的吗北京看白癜风医院哪家好
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