终末期肾病合并脑膜瘤患者的出血性视乳头水肿：一例病例报告

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中文摘要

前颅窝脑膜瘤可表现出一系列症状，给诊断带来挑战，尤其是在合并终末期肾病（ESRD）等显著合并症的患者中。我们报告一例病例，其视力丧失、头痛和嗅觉丧失的经典三联征最初因患者的肾脏背景和全身性炎症而变得复杂。一名53岁患有ESRD和高血压的女性，表现为一个月的进行性、不可矫正的双侧视力丧失和两周的头痛。她还报告完全嗅觉丧失。她的用药方案针对其合并症较为全面。未矫正和矫正视力为右眼6/10、左眼7/10。眼底镜检查显示双侧视乳头水肿伴视乳头周围出血。Marcus Gunn试验阴性。全身性炎症表现为ESR升高（51 mm/h）和CRP阳性。脑MRI证实存在脑膜瘤。她的血压控制在130/83 mmHg。该患者的表现是前颅窝脑膜瘤的典型描述，可能起源于嗅沟或蝶骨平台。该肿瘤通过直接神经压迫解释嗅觉丧失，并通过脑脊液通路梗阻和颅内压升高解释视乳头水肿。控制良好的血压和三联征的具体性质有助于排除高血压急症和尿毒症脑病作为主要原因。炎症标志物升高虽然最初引起对血管炎或其他炎症性疾病的怀疑，但也是脑膜瘤已知但较少见的伴随发现。本病例强调了即使对于医学上复杂的患者，也应追求神经系统症状的中枢神经系统（CNS）病因。视乳头水肿、头痛和嗅觉丧失的三联征高度提示前颅窝占位性病变，需要及时进行神经影像学检查。全身性炎症不应过早地使诊断检查偏离对原发性CNS肿瘤的考虑。

英文摘要

Anterior cranial fossa meningioma can present with a constellation of symptoms that pose a diagnostic challenge, especially in patients with significant comorbidities like end-stage renal disease (ESRD). We report a case where the classic triad of visual loss, headache, and anosmia was initially complicated by the patient's renal background and systemic inflammation. A 53-year-old woman with ESRD and hypertension presented with a one-month history of progressive, non-correctable bilateral visual loss and a two-week history of headache. She also reported complete anosmia. Her medication regimen was comprehensive for her comorbidities. Uncorrected and corrected visual acuity was 6/10 OD and 7/10 OS. Funduscopy revealed bilateral optic disc edema with peripapillary hemorrhages. The Marcus Gunn test was negative. Systemic inflammation was evidenced by an elevated ESR (51 mm/h) and a positive CRP. Brain MRI confirmed the presence of a meningioma. Her blood pressure was controlled at 130/83 mmHg. The patient's presentation is a classic depiction of an anterior cranial fossa meningioma, likely originating from the olfactory groove or planum sphenoidale. The tumor explains the anosmia via direct nerve compression and the papilledema via obstruction of CSF pathways and elevated intracranial pressure. The controlled blood pressure and the specific nature of the triad helped exclude hypertensive emergency and uremic encephalopathy as primary causes. The elevated inflammatory markers, while raising initial suspicion for vasculitis or other inflammatory conditions, are also a known, though less common, associated finding with meningioma. This case underscores the critical importance of pursuing a central nervous system (CNS) etiology for neurological symptoms, even in medically complex patients. The triad of papilledema, headache, and anosmia is highly suggestive of an anterior cranial fossa mass lesion and warrants prompt neuroimaging. Systemic inflammation should not prematurely divert the diagnostic workup from considering primary CNS tumors.