눈근육마비편두통 3예
Three Cases of Ophthalomplegic Migraine
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목적: 두통과 복시를 동반하는 눈근육마비편두통은 드문 질환으로 그 3례를 보고하고자 한다. 증례요약: 8세의 여자 환자 두 명과 44세 남자 환자가 두통 후에 발생한 복시를 주소로 내원하였다. 세 환자 모두 두통을 동반한 일시적 복시의 과거력이 있었으며 내원 당시 복시 및 안구운동 장애가 있었다. 첫 번째 증례는 첫 번째 발작에서는 좌안 4번 뇌신경마비를보였고 두 번째 발작에서는 우안 6번 뇌신경마비를 동반한 환자이고, 두 번째 증례는 동공을 침범한 3번 뇌신경마비와 안검하수를보였으며, 세 번째 증례는 중년에 시작된 6번 뇌신경마비를 동반한 환자이다. 세 환자 모두 시유발전위검사, 뇌척수액 검사, 혈액검사는 모두 정상이었고 다른 신경학적 검사에서도 이상소견이 발견되지 않았다. 또한 뇌 및 뇌혈관 자기공명영상촬영에서 종양이나 뇌혈관 이상 소견은 발견되지 않았다. 세 환자 모두 내원 수주 후부터 호전되기 시작하여 1달 후에는 복시 및 안구운동장애가 모두 정상으로 회복되어 눈근육마비편두통으로 진단하였다. 결론: 두통과 동반되는 눈근육마비 시 눈근육마비편두통을 염두에 두어야 하는데, 편두통의 병력 및 임상양상을 보이면서 신경학적검사 및 뇌영상검사에서 다른 뇌병변이 없을 때 눈근육마비편두통을 진단할 수 있다.
Abstract
Purpose: To report three cases of ophthalmoplegic migraine which is a rare condition characterized by the association of headaches with an oculomotor nerve palsy. Case summary: A 44-year-old male and two eight-year-old females were presented with diplopia developed after headaches. All of the three patients showed abnormal eye movement and they had past episodes of transient diplopia with headaches. Visual evoked potential (VEP), cerebrospinal fluid (CSF) examination, laboratory findings, and other neurologic tests were all normal,also there was no tumor or cerebrovascular disease on brain MRA & MRI. The symptoms of all patients improved gradually within several weeks from first the visit, with complete recovery seen in all three. Conclusions: Any patient who has a headache with paresis of the extraocular muscle should be considered for ophthalmoplegic migraine. To diagnose ophthalmoplegic migraine, family history, past medical history, associated symptoms and signs, neurologic examinations and neuroimaging tests are needed.
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