目的探讨以视力下降和视野缺损为首发症状的脑血管病的临床特征。方法回顾性分析2年内于我院神经内科住院的依视力下降和视野缺损为首发症状的48例脑血管病患者病例,对其临床症状做初步统计。结果患者主诉包括单眼视力下降、双眼先后视力下降、双眼偏侧视物不见和双眼同时视物不见。经专业检查后确诊前循环脑梗死5例,后循环脑梗死33例,脑血管畸形3例,烟雾病3例,颈动脉闭塞4例。前循环病变表现主要为单眼视功能障碍,后循环病变多表现单、双侧枕、颞叶梗死;基底动脉综合症及脑干梗死。后循环平均年龄高于前循环平均病变年龄。结论在以视功能障碍为首发的脑血管疾病中既有前循环病变也有后循环病变,但后循环比率明显高于前循环。单眼视觉功能障碍多为前循环病变,是颈内动脉病变的眼部症状;双眼功能障碍多为后循环病变累及枕颞叶所导致。 Objective To investigate the clinical features of cerebrovascular disease with the vision loss and visual field defect as the first symptom. Methods A retrospective analysis of 48 cases of cerebrovascular disease with diminished visual acuity and visual field defect as the first symptom in our department of neurology hospital in 2 years was retrospectively analyzed. Results Patients complained of decreased monocular vision, eyesight has decreased visual acuity, hemifacial hemoptysis disappeared and both eyes at the same time, depending on the material is not seen. After the professional examination confirmed the diagnosis of anterior circulation cerebral infarction in 5 cases, posterior circulation cerebral infarction in 33 cases, cerebrovascular malformation in 3 cases, moyamoya disease in 3 cases, carotid artery occlusion in 4 cases. The main manifestations of anterior circulation lesions for monocular visual dysfunction, multiple manifestations of posterior circulation lesions, bilateral occipital and temporal lobe infarction; basilar artery syndrome and brainstem infarction. The average age of the posterior circulation is higher than the average age of the anterior circulation. Conclusions There are both anterior circulation lesions and posterior circulation lesions in cerebrovascular diseases with visual dysfunction as the first episode, but the posterior circulation ratio is obviously higher than the anterior circulation. Monocular visual dysfunction and more for the first anterior circulatory disease, is the intracranial artery lesions of the eye symptoms; binocular dysfunction mostly caused by the involvement of posterior circulation lesions occipital temporal lobe.