두개강내 동맥류 환자의 신경안과적 분석
The Neuro-ophthalmic Presentation of Intracranial Aneurysms
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목적: 두개강내 동맥류 환자에서 발생한 신경안과 진단 및 임상양상에 대해서 알아보고자 하였다. 대상과 방법: 2008년 4월부터 2016년 12월까지 두개강내 동맥류로 진단 받은 환자 중에서 신경안과 검사가 시행된 환자 33명을 대상으로 후향적인 분석을 시행하였다. 영상검사 및 신경외과, 신경안과 의무기록을 통해 안과에서 동맥류를 발견한 빈도, 신경안과 진단 및 예후, 동맥류의 위치, 동맥류 파열 여부 등을 알아보았고 터슨증후군이 동반된 환자의 신경학적 예후도 조사하였다. 결과: 전체 환자 33명에서 2명만이 안과에서 두개강내 동맥류를 먼저 발견하였고, 대부분의 환자 31명(94%)은 신경외과에서 동맥류를 발견하였다. 신경안과 진단으로는 3번뇌신경마비가 10명(30%)으로 가장 많았고 핵간안근마비, 시야결손, 시신경위축, 6번뇌신경마비, 안구진탕 등이 발생하였다. 동맥류 위치는 전교통동맥이 13예(39%)로 가장 많았고 12예, 후교통동맥 5예 순이었다. 전체 33명 중 10명에서 터슨증후군이 동반되었고, 최종 관찰 시 6명(60%)에서 인지장애, 보행장애 등의 영구적인 신경학적 장애가 발생하였다. 결론: 두개강내 동맥류 환자에서 가장 많이 발생하는 신경안과 질환은 3번뇌신경마비였다. 신경안과 질환의 예후는 비교적 양호하였으나, 터슨증후군이 동반된 환자의 신경학적 예후는 좋지 않았다.
Abstract
Purpose: To investigate the neuro-ophthalmic diagnosis and clinical manifestations of intracranial aneurysm. Methods: A retrospective survey of 33 patients who were diagnosed with intracranial aneurysm and underwent neuro-ophthalmic examination from April 2008 to December 2016. Frequency of the first diagnosis of intracranial aneurysm in ophthalmology, neuro-ophthalmic diagnosis, location of intracranial aneurysm, examination of intracranial aneurysm rupture, and neurologic prognosis of Terson’s syndrome patients were analyzed by image examination, neurosurgery, and ophthalmology chart review. Results: Of the 33 patients, most patients (n = 31, 94%) were diagnosed with intracranial aneurysm at the neurosurgical department and only 2 patients were diagnosed initially at the ophthalmology department. Causes and association were: Terson’s syndrome (n = 10, 30%), third cranial nerve palsy (n = 10, 30%), internclear ophthalmoplegia (n = 4, 12%), visual field defect (n = 3, 9%), optic atrophy (n = 3, 9%), sixth cranial nerve palsy (n = 2, 6%), and nystagmus (n = 1, 3%). The location of intracranial aneurysms were: anterior communicating artery (n = 13, 39%), medial communicating artery (n = 12, 36%), and posterior communicating artery (n = 5, 15%). Ten of 33 patients had Terson’s syndrome, and 6 patients (60%) with Terson’s syndrome had a permanent neurological disorder such as agnosia, gait disorder and conduct disorder. Conclusions: Third cranial nerve palsy was the most common neuro-ophthalmic disease in patients presenting with intracranial aneurysm. The neuro-ophthalmic prognoses for those diseases were relatively good, but, if Terson’s syndrome was present, neurological disorders (agnosia, gait disorder, conduct disorder) were more likely to remain after treatment.
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