정맥동 혈전증에 의한 시신경유두부종
Papilledema with Cerebral Venous Sinus Thrombosis
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목적: 양안 시신경유두부종이 관찰된 2명의 환자에서 정맥동 혈전증을 진단하여 이를 보고하고자 한다. 증례요약: 증례 1) 27세 남자 환자가 2달 전부터 발생한 두통 및 구토, 양안 시야 흐림을 주소로 내원하였다. 최대교정시력은 우안1.0, 좌안 1.0이었으며, 시야검사에서 양안 주변부 시야결손, 빛간섭단층촬영 및 안저검사에서 양안 시신경유두부종이 관찰되었다. 뇌 자기공명영상에서는 정상 소견을 보였으나 뇌 자기공명정맥조영검사에서 횡정맥동 충만결손 소견이 있었고, 뇌척수액검사에서 뇌압상승 소견을 보였다. 증례 2) 54세 여자 환자가 양안 시신경유두부종으로 의뢰되었다. 최대교정시력은 우안 0.9, 좌안 1.0이었으며, 시야검사에서 우안 하이측 시야결손과 맹점확대 소견, 빛간섭단층촬영 및 안저검사에서 양안 시신경유두부종이 관찰되었다. 뇌 자기공명영상에서는 정상 소견을 보였으나 뇌 자기공명정맥조영검사에서 횡정맥동, 구불정맥동에서의 혈류 감소 소견이 있었으며, 뇌척수액검사에서 뇌압상승 소견을 보였다. 결론: 양안의 시신경유두부종이 있는 경우 정맥동 혈전증에 의한 유두부종의 가능성을 고려하여 뇌 자기공명영상과 함께 뇌 자기공명정맥조영검사를 고려하여야 할 것으로 생각된다.
Abstract
Purpose: We report two patients diagnosed with a sinus thrombosis with papillary edema. Case summary: Case 1 was a 27-year-old male who presented with complaints of headache and vomiting for 2 months and blurred vision in both eyes. The best-corrected visual acuity (BCVA) was 1.0 in the right eye and 1.0 in the left eye. A visual field (VF) examination revealed a binocular peripheral VF defect and optical coherence tomography (OCT) and a fundus examination indicated optic disc swelling in both eyes. Brain magnetic resonance imaging (MRI) showed no specific finding but magnetic resonance venography revealed filling defect signs in the transverse sinus and a cerebrospinal fluid examination indicated elevated intracranial pressure (ICP). Case 2 was a 54-year-old female who came to our hospital with suspicion of bilateral optic disc swelling. The BCVA was 0.9 in the right eye and 1.0 in the left eye. A VF examination revealed an inferior-temporal VF defect and blind spot enlargement in the right eye. OCT and a fundus examination showed optic disc swelling in both eyes. Brain MRI showed no specific finding but magnetic resonance venography revealed a decrease in blood flow in the transverse sinus, sigmoid sinus. A cerebrospinal fluid examination indicated elevated ICP. Conclusions: In the case of optic disc swelling in both eyes, a secondary cause of ICP elevation and the possibility of optic disc swelling due to sinus thrombosis should be considered, and brain MRI and venography are needed to distinguish these possibilities.
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