다발성 뇌경색 후에 나타난 내사시를 동반한 후천안운동행위상실증 1예
A Case of Acquired Ocular Motor Apraxia Accompanied with Esotropia due to Multiple Brain Infarcts
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목적: 다발성 뇌경색 후 발생한 내사시를 동반한 후천안운동행위상실증 1예를 경험하였기에 보고하고자 한다. 증례요약: 9년 전 우측 소뇌, 우측 후두엽, 숨뇌, 교뇌 하부에 발생한 다발성 뇌경색의 과거력이 있는 59세 남자 환자가, 뇌경색 이후지속된 복시를 주소로 안과에 의뢰되었다. 초진 당시 최대교정시력은 우안 0.9, 좌안 0.8이었고, 원거리 및 근거리 교정사시각은 12프리즘디옵터(PD)의 내사시였다. 한눈보기/두눈보기 검사에서 정상이었으나, 수평신속운동이 감소해 있었다. 내원 2년 8개월 후, 원거리 및 근거리에서 15 PD의 내사시를 보였다. 한눈보기/두눈보기 검사는 정상이었고, 수직신속운동은 유지되었으나, 수평신속운동은상실되어 있었다. 또한 신속운동을 지시하였을 때 특징적인 머리를 흔드는 동작이 관찰되었다. 이에 내사시를 동반한 후천안운동행위상실증으로 진단 후 경과관찰 중, 두눈 뇌직근 후전술을 시행 받고 복시 증상 및 내사시는 호전되었다. 결론: 다발성 뇌경색으로 인하여 내사시를 동반한 후천안운동행위상실증이 발생할 수 있으며, 뇌경색의 병력이 있는 환자에서는 다양한 양상의 안구운동장애가 함께 나타날 수 있음을 알아야 한다.
Abstract
Purpose: We present a case of acquired ocular motor apraxia accompanied with esotropia due to multiple brain infarcts. Case summary: A 59-year-old male was referred for diplopia that started 9 years before presentation and continued after multiplebrain infracts including right cerebellum, right occipital lobe, medulla oblongata and inferior pons. At initial examination, hisbest corrected visual acuity was 20/22 in the right eye and 20/25 in the left eye and he had 12 prism diopter (PD) esotropia at distanceand near in primary gaze with correction. His duction and version were normal; however, his horizontal saccade was notablydecreased. Two years and 8 months after presentation, the patient had 15 PD esotropia at distance and near with correction. His duction and version were normal and vertical saccadic eye movements were observed. However, horizontal saccadedisappeared. The patient also exhibited a distinguishing head thrust following the order for saccadic eye movement. He was diagnosedwith an acquired ocular motor apraxia accompanied with esotropia. During the follow-up period the patient underwentbilateral recession of the medial rectus. The usual diplopia and his horizontal esodeviation improved to 3 PD of esotropia atdistance. Conclusions: Multiple brain infarcts can result in an acquired ocular motor apraxia accompanied with esotropia. Varying types ofocular motor disorders should be considered in patients with a previous medical history of brain infarct.
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