以頭部外傷後視力喪失為初始表現的顱內腫瘤

Intracranial Tumor Presenting as Visual Loss Following Head Trauma

本文描述一位95歲男性，跌倒撞到額頭發現右眼視力喪失。經由專科護理師完整病史收集丶身體評估及協助眼科理學檢查結果，初步診斷為視神經病變。眼底攝影檢查及光學同調斷層掃描顯示，右眼視神經盤略為蒼白及視神經纖維變薄，腦部電腦斷層及磁振造影檢查發現，篩竇後方及右側眼窩尖端有浸潤現象並向顱內廷伸，須排除侵襲性徽茵鼻竇炎或淋巴瘤侵犯之可能性。會診耳鼻喉科評估介入處置，切片後經病理報告證實為腦膜瘤。藉此案例提供醫療人員留意，本案例雖不屬腦膜瘤好發族群，但年紀大合併多種慢性共病，應全面性病史收集、加強理學檢查、輔以影像學檢查，積極探查可能病因，早期診斷治療，以免延誤治療黃金時期，導致永久性視力損傷。

The case involves a 95-year-old male. He experienced a fall resulting in the loss of vision in his right eye. Comprehensive history taking, physical assessment, and ophthalmologic examination were performed by the nurse practitioners led to an initial diagnosis of optic neuropathy. Fundus photography and optical coherence tomography showed mild pallor of the right optic disc and thinning of the optic nerve fibers. Computed tomography and magnetic resonance imaging of train showed infiltration behind the ethmoid sinuses and the apex of the right orbit extending intracranially, raising concerns for invasive fungal sinusitis or lymphoma involvement. This case underscores the importance for healthcare professionals to be vigilant, as this patient, despite not being in the typical age group for meningioma, had multiple chronic comorbidities. Comprehensive history taking, enhanced physical examination, and supportive imaging studies are crucial for actively investigating potential causes. Early diagnosis and treatment are essential to prevent permanent vision loss by avoiding delays in the treatment window.