뇌 자기공명영상에서 시신경교차의 조영증강을 보인 에탐부톨로 인한 독성시신경병증
Optic Chiasmal Enhancement Revealed by Magnetic Resonance Imaging in a Patient with Ethambutol-induced Toxic Optic Neuropathy
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 양이측반맹을 보인 에탐부톨로 인한 독성시신경병증 환자에서 시신경교차의 조영증강을 확인하였기에 이를 보고하고자 한다. 증례요약: 53세 여자가 2달 전부터 서서히 진행된 양안 시력저하로 왔다. 폐결핵으로 10개월 동안 에탐부톨 800 mg 복용 중, 시력저하로 내원 1개월 전 약물을 중단하였다. Rifampicin 600 mg, clarithromycin 1,000 mg은 11개월간 매일 복용 중이었다. 교정시력은우안 0.2, 좌안 0.1이었다. 양안 색각저하를 보였다. 시야검사에서 양이측반맹을 보였으며, 좌안 시야결손이 더 심하였다. 뇌 자기공명영상에서 좌측이 더 심한 시신경교차의 조영증강을 확인하였고, 시야장애의 형태와 동일하게 좌측이 더 심하였다. 1달 뒤 경과 관찰에서 시력저하는 더 심해졌다. 3일간 고농도 스테로이드 정맥 주사 치료(methylprednisolone 1,000 mg)를 시행하였다. 경과 관찰 1년후의 교정시력 우안 0.4, 좌안 0.1이었으며, 시야장애는 호전을 보였다. 결론: 에탐부톨로 인한 독성시신경병증에서 양이측반맹이 나타날 수 있으며, 뇌 MRI를 통해 시야장애와 일치하는 시신경교차의 조영증강을 확인할 수 있다.
Abstract
Purpose: We report a bitemporal visual field defect accompanied by optic chiasmal enhancement in a patient with ethambutol (EMB)-induced toxic optic neuropathy. Case summary: A 53-year-old woman presented with bilateral visual disturbance that had gradually worsened over the prior 2 months. She had been prescribed 800 mg EMB daily to treat pulmonary tuberculosis for the past 10 months but had stopped EMB 1 month prior because of visual disturbance. She had been prescribed 600 mg rifampicin and 1,000 mg clarithromycin daily for 11 months. Her visual acuity was 0.2 in the right eye and 0.1 in the left. Color vision was reduced. Automated perimetry demonstrated a bitemporal visual field defect, which was more severe in the left eye. Magnetic resonance imaging (MRI) of the optic chiasm revealed contrast enhancement in the body of the chiasm. The optic nerve of the left eye evidenced a higher signal intensity than did that of the right, consistent with the visual field test results. One month after her initial visit, the visual symptoms deteriorated further. We delivered high-dose, intravenous steroid pulse therapy (methylprednisolone 1,000 mg daily for 3 days). At the 1-year follow-up, the visual acuity was 0.4 in the right eye and 0.1 in the left. Conclusions: Bitemporal hemianopia may develop in patients with EMB-induced toxic optic neuropathy. Enhancement of the optic chiasm, consistent with the visual field defect, could be observed in MRI.
참고문헌 (15)
- Chen SC, "Incidence and prognostic factor of ethambutol-related optic neuropathy : 10-year experience in southern Taiwan", Kaohsiung J Med Sci, 31, pp.358~362 (2015)
- Lee EJ, "Incidence and clinical features of ethambutol-induced optic neuropathy in Korea", J Neuroophthalmol, 28, pp.269~277 (2008)
- Lim SA, "Ethambutol-associated optic neuropathy", Ann Acad Med Singap, 35, pp.274~278 (2006)
- Chawla JP, "Ethambutol chiasmal toxicity with bitemporal hemianopia", Semin Ophthalmol, 24, pp.221~224 (2009)
- 이혜진, "양이측반맹을 보인 에탐부톨 시신경병증", 대한안과학회지, 56(12), pp.1997~2003 (2015), 대한안과학회
- Osaguona VB, "Optic chiasm involvement on MRI with ethambutol-induced bitemporal hemianopia", J Neuroophthalmol, 34, pp.155~158 (2014)
- Lu PG, "Ethambutol optic neuropathy associated with enhancement at the optic chiasm", Can J Ophthalmol, 52, pp.e178~81 (2017)
- Kidd D, "The optic chiasm", Clin Anat, 27, pp.1149~1158 (2014)
- Schmidt IG, "Studies on the neurotoxicity of ethambutol and its racemate for the rhesus monkey", J Neuropathol Exp Neurol, 25, pp.40~67 (1966)
- Geyer HL, "Optochiasmatic and peripheral neuropathy due to ethambutol overtreatment", J Neuroophthalmol, 34, pp.257~258 (2014)
- Elschot EP, "A comprehensive view on MRI techniques for imaging blood-brain barrier integrity", Invest Radiol, 56, pp.10~19 (2021)
- Jayanetti V, "Sibling ethambutol optic chiasmopathy", Neuroophthalmology, 42, pp.40~43 (2017)
- Tieger MG, "Ganglion cell complex loss in chiasmal compression by brain tumors", J Neuroophthalmol, 37, pp.7~12 (2017)
- 신정욱, "빛간섭단층혈관조영술을 이용한 에탐부톨에 의한 독성시신경병증에서의 시신경 주위 혈관 분석", 대한안과학회지, 63(1), pp.75~82 (2022), 대한안과학회[DOI]
- Dhiman R, "Neuro-ophthalmic manifestations of tuberculosis", Eye(Lond), 36, pp.15~28 (2022)