얼음검사 양성을 보인 비-눈근육무력증 2예
Two Cases with Positive Ice Tests Mimicking Ocular Myasthenia Gravis
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목적: 복시와 눈꺼풀처짐을 주소로 내원한 환자가 얼음검사에서 양성을 보였지만 눈근육무력증 이외의 다른 원인이 있었던 증례 2예를 보고하고자 한다. 증례요약: 1주 전부터 시작된 좌안 내전장애와 눈꺼풀처짐을 주소로 내원한 35세 여자 환자는 얼음검사 양성이었지만, 혈청 항아세틸콜린수용체 결합항체와 반복신경자극검사에서 음성이었고 뇌혈관조영술에서 좌측 후교통동맥의 동맥류가 관찰되어 동공을 침범하지않은 좌측 동안신경마비이었다. 8달 전부터 시작된 간헐적인 수평복시와 우안 눈꺼풀처짐을 주소로 내원한 25세 여자 환자는 얼음검사 양성이었지만, 혈청 항아세틸콜린수용체 결합항체와 반복신경자극검사에서 음성이었고 항핵항체 양성(1:160)이었다. 결론: 얼음검사는 중증근무력증의 유용한 선별검사이지만, 눈꺼풀처짐과 안구운동장애를 보일 수 있는 다른 감별진단에서도 양성일수 있어 주의가 필요하다.
Abstract
Purpose: To report two patients with positive ice tests who had diplopia and blepharoptosis caused by something other than ocularmyasthenia gravis. Case summary: A 35-year-old female presented with a one-week history of inability to adduct the left eye and left blepharoptosis. Although the ice test was positive, serum anti-acetylcholine receptor binding antibody and the repetitive nerve stimulation testwere negative. Brain angiography showed an aneurysm of the left posterior communicating artery, leading to the diagnosis of leftpupil-sparing oculomotor nerve palsy. A 25-year-old female presented with an 8-month history of intermittent horizontal diplopiaand blepharoptosis in the right eye. The ice test was positive, however serum anti-acetylcholine receptor binding antibody andthe repetitive nerve stimulation test were negative. Anti-nuclear antibody was positive (titer 1:160). Conclusions: The ice test is a useful screening test for myasthenia gravis. However, a series of differential diagnoses includingblepharoptosis and ocular motility disorder should be considered because these conditions also show a positive result in the icetest.
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