단안의 비측 반맹으로 발현된 내경동맥류
Internal Carotid Artery Aneurysm Presenting with Unilateral Nasal Hemianopsia
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목적: 단안의 비측 반맹을 보인 환자에서 내경동맥류를 진단하여 이를 보고하고자 한다. 증례요약: 고혈압 이외의 다른 병력이 없는 56세 여자환자가 건강검진에서 우연히 발견된 좌안의 시신경유두함몰비 증가를 주소로내원하였다. 최대교정시력은 양안 20/20이었고, 세극등현미경검사에서 특이소견은 없었으며 시신경유두함몰비는 우안이 0.6, 좌안이0.75였다. 양안 모두 상대구심동공운동장애나 색각이상은 없었다. 험프리시야검사에서 우안은 명확한 시야결손이 없었고 좌안은 수직경선을 따르는 비측 반맹이 있었다. 뇌 컴퓨터단층촬영 및 혈관조영술에서 지름 2.2 cm 크기의 내경동맥류가 확인되었다. 결론: 단안의 비측 시야장애가 있는 환자에서 안내질환이 배제되면 내경동맥류가 원인일 가능성을 고려해야 하겠다.
Abstract
Purpose: To report a case of unilateral nasal hemianopsia caused by a large internal carotid artery aneurysm. Case summary: A 56-year-old female presented with large cupping in the left optic nerve head detected incidentally during a routinecheck-up. She had no underlying systemic disease except hypertension. The best corrected visual acuity was 20/20 in botheyes and a slit-lamp examination showed no abnormal findings. Ophthalmoscopy showed cup/disc ratios of 0.6 in the right eyeand 0.75 in the left eye. Relative afferent papillary defect or color vision defect was not observed. A Humphrey visual-field test indicatedunilateral nasal hemianopsia in the left eye. Brain CT and angiography revealed a large 2.2-cm aneurysm on the left internalcarotid artery. Conclusions: Internal carotid artery aneurysm should be considered as a possible cause of unilateral nasal hemianopsia in patientswithout intraocular lesion.
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