암 병력을 가진 3, 4, 6번 단독 뇌신경마비의 원인 분석
Etiology of Isolated Third, Fourth, and Sixth Cranial Nerve Palsies with a Cancer History
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 암 병력을 가진 3, 4, 6번 단독 뇌신경마비 환자를 대상으로 발병 원인을 알아보고자 하였다. 대상과 방법: 2013년 3월부터 2021년 12월까지 암 병력을 가진 환자 중 3, 4, 6번 단독 뇌신경마비로 진단된 환자 30명을 대상으로발병 원인에 대해 후향적으로 분석하였다. 결과: 30명의 환자 중 6번 뇌신경마비가 18명(60.0%)으로 가장 많았다. 원발암의 뇌 전이로 인해 3, 4, 6번 뇌신경마비가 발생한 경우가 13명(43.3%)으로 가장 많았으며, 미세혈관성 원인이 11명(36.7%), 방사선 치료 연관 신경병증 2명(6.7%), 원인 불명 4명(13.3%)이었다. 뇌 전이로 인한 마비와 그 외의 원인으로 나누어 비교하였을 때, 뇌 전이로 인한 환자 13명 중 기존에 진단되었던 암이 1년 이상완전 관해 상태인 경우는 1명(7.7%)이었고, 그 외의 원인에 의한 환자의 경우 17명 중 7명(41.2%)에서 1년 이상 완전 관해 상태였다. 결론: 암 병력을 가진 3, 4, 6번 단독 뇌신경마비 환자에서 원발암의 뇌 전이가 마비의 원인인 경우가 가장 많았으며, 특히 1년 이상원발암의 관해 상태가 아닌 경우 그 가능성이 높았다. 암 병력을 가진 3, 4, 6번 뇌신경마비 환자에서는 뇌 전이를 감별하기 위해가능한 빠른 시기에 뇌 자기공명영상검사를 시행해야 하며, 뇌 전이 외에도 다양한 원인에 대한 감별 진단이 중요하겠다.
Abstract
Purpose: To investigate the causes of isolated ocular motor nerve palsy in patients with a history of cancer. Methods: The charts of 30 patients with cancer diagnosed with isolated acquired third, fourth, and sixth cranial nerve palsies from March 2013 to December 2021 were retrospectively reviewed. Sex, age of onset, underlying disease and causes of cranial nerve palsy were analyzed. Results: Sixth cranial nerve palsy (n = 18, 60.0%) was the most common. Brain metastasis (n = 13, 43.3%) was the most common etiology, followed by microvascular causes (n = 11, 36.7%), radiation-induced neuropathy (n = 2, 6.7%), and undetermined (n = 4, 13.3%). Among the 13 patients with palsies due to brain metastasis, only one (7.7%) had been in complete remission for more than 1 year. Of the remaining 17 patients with other causes, seven (41.2%) had been in complete remission of a previously diagnosed cancer for more than 1 year. Conclusions: In patients with a history of cancer, cranial nerve palsy due to brain metastasis was the most common cause, and it was more likely if the primary cancer had not been in remission for more than 1 year. Brain magnetic resonance imaging should be performed as soon as possible to confirm brain metastasis and a differential diagnosis including various other causes is also important.
참고문헌 (17)
- Richards BW, "Causes and prognosis in 4, 278 cases of paralysis of the oculomotor, trochlear, and abducens cranial nerves", Am J Ophthalmol, 113, pp.489~496 (1992)
- Park UC, "Clinical features and natural history of acquired third, fourth, and sixth cranial nerve palsy", Eye(Lond), 22, pp.691~696 (2008)
- 이주황, "후천제삼뇌신경마비의 임상양상과 자연경과", 대한안과학회지, 61(11), pp.1338~1347 (2020), 대한안과학회
- Kung NH, "Isolated ocular motor nerve palsies", Semin Neurol, 35, pp.539~548 (2015)
- Rucker CW, "Paralysis of the third, fourth and sixth cranial nerves", Am J Ophthalmol, 46, pp.787~794 (1958)
- Rush JA, "Paralysis of cranial nerves III, IV, and VI. Cause and prognosis in 1,000 cases", Arch Ophthalmol, 99, pp.76~79 (1981)
- 김형진, "뇌신경 III–XII의 정상 자기공명영상 소견", 대한영상의학회지, 81(3), pp.501~529 (2020), 대한영상의학회[DOI]
- Murchison AP, "Neuroimaging and acute ocular motor mononeuropathies : a prospective study", Arch Ophthalmol, 129, pp.301~305 (2011)
- Tamhankar MA, "Isolated third, fourth, and sixth cranial nerve palsies from presumed microvascular versus other causes : a prospective study", Ophthalmology, 120, pp.2264~2269 (2013)
- 홍세리, "Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2018", Cancer Research and Treatment, 53(2), pp.301~315 (2021), 대한암학회[DOI]
- Jung JS, "Risk factors and prognosis of isolated ischemic third, fourth, or sixth cranial nerve palsies in the Korean population", J Neuro Ophthalmol, 35, pp.37~40 (2015)
- Patel SV, "Diabetes and hypertension in isolated sixth nerve palsy : a population-based study", Ophthalmology, 112, pp.760~763 (2005)
- Grassmeyer JJ, "Radiation-induced bilateral oculomotor nerve palsy 20 years after radiation treatment", Neurology, 96, pp.955~957 (2021)
- Lin YS, "Radiation-related cranial nerve palsy in patients with nasopharyngeal carcinoma", Cancer, 95, pp.404~409 (2002)
- Dong Y, "Incidence and outcomes of radiation-induced late cranial neuropathy in 10-year survivors of head and neck cancer", Oral Oncol, 95, pp.59~64 (2019)
- Sumrall AL, "Neurological Complications of Systemic Cancer and Antineoplastic Therapy" (2022), Academic Press
- Pan Z, "Leptomeningeal metastasis from solid tumors : clinical features and its diagnostic implication", Sci Rep, 8, pp.10445~ (2018)