idiopathic uveoencephalitis
Introduction
Introduction to idiopathic uveal encephalitis Idiopathic uveal encephalitis, also known as pigmented meningitis, is a combination of Vogtt and Koyanagl (Koyanagi) reported with ocular anterior segment inflammation, accompanied by white hair, hair loss, leukoplakia and hearing impairment. Later, Harada (Harada) reported that the bilateral eye exudative uveitis, which is mainly caused by the posterior segment of the eye, is similar to this disease. Therefore, it is also called Vogt-Koyanai-Halada syndrome (VKH). basic knowledge The proportion of illness: 0.001% Susceptible people: no specific population Mode of infection: non-infectious Complications: anterior chamber hemorrhage scleritis pigmented spots retinal vasculitis choroidal neovascularization
Cause
Idiopathic uveal encephalitis
The cause is unknown, there are two kinds of assumptions.
1, may be related to viral infections.
2. At present, it is considered that autoimmune diseases are likely to have pathogenic factors such as viruses acting on susceptible organisms, causing non-specific pro-term symptoms, and other pathogenic factors causing antigenic changes in pigment cells, and autoimmunity occurs. In response, various clinical fragments of systemic pigment cells are damaged.
Prevention
Idiopathic uveal encephalitis prevention
Because the cause is unknown, there are no clear and effective preventive measures. Early detection and timely treatment are best practices.
Complication
Idiopathic uveal encephalitis complications Complications, anterior chamber, scleritis, pigmented plaque, retinal vasculitis, choroidal neovascularization
Anterior segment
Anterior chamber hemorrhage, iris nodules, anterior or posterior adhesions around the iris, scleritis, low intraocular pressure, or elevated intraocular pressure caused by ciliary body advancement.
2. Posterior segment
After serous retinal detachment, pigment plaques of varying sizes and retinal pigment epithelium atrophy were observed, showing a haze-like fundus; retinal vasculitis, choroidal neovascularization, and Dalen-Fuchs nodules.
Symptom
Idiopathic uveal cerebral inflammatory symptoms Common symptoms Nausea retinal detachment Tinnitus membranous nerve damage Meningeal irritation Symptoms Dizziness
1, manifested as headache, dizziness, nausea, vomiting, neck stiffness and other meningeal irritation, 50% of patients with small willow type have meningeal irritation; the original field type can be as high as 90%, uveitis occurs shortly after these symptoms appear.
2, 3 to 5 days after the symptoms of the prodromal period, eye symptoms, eye pain, red eyes, vision loss, the eye performance is:
(1) Vogt-Koyanagi type: mainly exudative iridocyclitis, also accompanied by diffuse chorioretinitis, a large amount of anterior chamber exudation, covering the pupil area, severe extensive post-iris adhesion, the fundus is not clear, connected to each Complications and sequelae.
(2) Harada type: the visual acuity of both eyes suddenly drops, and the changes of the nodes are obvious. The edema of the nipple and macular area is obvious, and the whole fundus edema gradually forms, which leads to retinal detachment. At the same time, diffuse atrophy of the pigment epithelium and vitreous opacity, inflammation also occurs. It can spread forward, but the smaller willow is lighter.
3, auditory and skin lesions: after several weeks or months after the onset of eye symptoms, there are signs of tinnitus, hearing, whitening hair, gelatin and vitiligo, these are changes in the labyrinth of the labyrinth, and Mostly symmetrical.
4, recovery period: repeated authors, the disease gradually worsened, may appear iris atrophy, pupillary membrane closure or complicated cataract, secondary glaucoma and even eye atrophy, Harada type subretinal fluid absorption, retinal reattachment, retinal pigmentation Lost, forming a "sunset-like" fundus (also known as "sunset red").
Examine
Examination of idiopathic uveal encephalitis
1. History: Whether there is nervous system damage, hearing loss or hair loss, with or without eye trauma or surgery.
2. Comprehensive eye examination.
3. Complete blood count, RPR, FTA-ABS, ACE, PPD + non-allergic reaction plate, chest X-ray examination, to exclude clinically similar diseases.
4. When there are symptoms of the nervous system, brain CT or MRI excludes central nervous system diseases.
5. There is a meningeal irritation sign for lumbar puncture and cerebrospinal fluid examination.
6. Fundus fluorescein angiography.
Diagnosis
Diagnosis and diagnosis of idiopathic uveal encephalitis
diagnosis:
1. Clinical symptoms: diffuse uveitis in both eyes, the anterior segment develops into granulomatous inflammation, the posterior nipple and macular end local retinal detachment, and the late "evening glow" fundus.
2, accompanied by changes in hair and skin.
3, often need to be identified with comprehensive uveitis, Behcet's disease.
Differential diagnosis:
1. Sympathetic ophthalmia.
2. Acute multiple squamous pigmented epithelial changes.
3. Granulomatous whole uveitis.
