소아 환자에서 엡스타인-바 바이러스 뇌염에 동반된 양안 외향신경마비
Bilateral Abducens Nerve Palsy in Pediatric Patients with Epstein-Barr Virus Encephalitis
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목적: 소아 환자에서 엡스타인-바 바이러스(Epstein-Barr virus, EBV) 뇌염과 동반된 양안 외향신경마비 증례를 보고하고자 한다. 증례요약: 증례 1. 특이병력 없는 14개월 남아가 5일전부터 시작된 발열과 45PD 좌안 내사시를 주소로 내원하였다. 양안 외전장애 외에다른 신경학적 검사상 특이소견은 발견되지 않았으나, 혈청검사와 뇌척수액검사에서 EBV 양성소견을 보여 항바이러스 치료 및 가림치료를 시행하였고 7개월 후 잔류 내사시에 대해 좌안 내직근 후전술 6.5 mm, 외직근 절제술 6 mm를 시행하였다. 수술 1주일 후환아는 정위를 보였고 신경학적 후유증은 없었다. 증례 2. 13세 남아가 5일전부터 시작된 두통과 발열, 2일전부터 시작된 의식저하와발작을 주소로 내원하였고 혈청검사에서 EBV 양성소견, 뇌척수액검사에서 바이러스 감염소견이 있어 항바이러스 치료를 시행하였다. 환아는 2주 뒤 의식회복 후 복시를 호소하였고 30PD 좌안 내사시와 양안 외전장애가 관찰되었다. 4개월간 가림치료 후 환아는 정위를보였고 외전장애도 관찰되지 않았으나 발작조절을 위해 항경련제를 지속적으로 복용하였다. 결론: 소아에서 엡스타인-바 바이러스 뇌염은 양안 외향신경마비와 동반될 수 있고 이로 인한 잔류 내사시와 신경학적 후유증이 지속될 수 있다.
Abstract
Purpose: To report 2 cases that presented with bilateral abducens nerve palsy associated with Epstein-Barr virus (EBV)encephalitis in children. Case summary: Case 1. A 14-month-old boy presented with fever and esodeviation of the left eye that started 5 days earlier. On the ophthalmic examination, 45-PD esotropia of the left eye and limitation of abduction in both eyes were observed. On neurological examination, there were no abnormalities. Serologic test and polymerase chain reaction (PCR)from cerebrospinal fluid (CSF) were positive for EBV. The patient was treated with systemic acyclovir and prednisolone. Part-time occlusion therapy of the right eye for 2 hours/day was also prescribed. The patient underwent a 6.5-millimeter recession of the medial rectus and a 6-millimeter resection of the lateral rectus on the left eye 7 months after the presentation. The patient showed orthotropia 1 week after the surgery without neurologic sequelae. Case 2. A 13-year-old boy presented with headaches and fever that started 5 days before and altered consciousness with seizures 2 days previously. Serological test for viral infection was normal, except for EBV, and CSF examination showed viral infection. After the patient recovered consciousness, he complained of diplopia. A 30-PD esotropia of his left eye with bilateral limitation of abduction was present. Alternating full-time occlusion of both eyes was prescribed. At 4 months after presentation,diplopia disappeared and the patient showed orthotropia without abduction limitation; however, anticonvulsants were prescribed to control seizures. Conclusions: In children, EBV encephalitis can be accompanied by acquired bilateral abducens nerve palsy. Residual nerve palsy and other neurologic sequelae can remain after several months.
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