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울혈유두 및 뇌척수액 소견상 albuminocytologic dissociation이 현저한 2례

Two cases of papilledema associated with typical albumino cytologic dissociation in spinal fluids

대한안과학회지 1966년 7권 2호 p.113 ~ 119
김희철 (  ) - 부산대학교 의과대학 안과학

박병국 (  ) - 부산대학교 의과대학 안과학

Abstract


The purpose of this paper is to call attention to the occasional occurrence of papilledema associated with typical albuminoytologic dissociation in spinal fluids.
In view of the possible allergic etiology of the syndrome by Reitman, ACTH and corticosteroids have been tried. These drugs have yielded encouraging results when treatment was initiated early in the course of the illness, when nerve-root edema had caused only functional paralysis but the syndromes of my cases hadn´t responded to prednisolone. It can be deduced that the illness is thought to be too advanced and the nerve-root had had organic destructions.alreadys our cases revealed prolonged typical albuminocytologic dissociation in spinal fluids, increased intracranial pressure throughout the whole hospital course and papilledema.
This condition is really a very common one but there is so much confusion about the criteria necessary for the diagnosis and so many different ´names are employed to designate it that its incidence is thought to be underestimated.
A review of the literature dealing with Guillain-Barre syndrome reveals few references to papilledema. Occasional notes of "optic neuritis" are found but the descriptions are not sufficient to enable one to determine whether there was papilledema or not.
In the author´s cases, the optic nerve heads showed papilledema of 3 diopters or more with tortuosities of the veins and filling of the cups. There were no hemorrhages or exudates.
Although not essential, the demonstration of an increased protein in cerebrospinal fluids with little or no elevation of cells is an appreciable aid in diagnosis on the Guillain-Barr´e syndrome. Certainly this patient, with a protein content of from 243 mg to 1, 200mg% in 8 successive lumbar punctures with cell counts ranging from zero to 29 lymphocytes per cubic millimeter demonstrates typical albuminocytologic dissociation.
Walsh postulsted one more element to this syndrome and pointed out that increased intracranial pressure may occur in cases otherwise typical of the Guillain-Barre syndrome. It is scarecely necessary to add the casuse of this condition, if indeed there is one cause and not many cases, is quite unknown. In the author´s cases, the intracranial pressure revealed from 110 mmH₂O to 520mmH₂O in 8 successive lumbar punctures.

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