뇌실주위백질연화증 환자에서 동반된 시신경 위축과 시야 결손 1예
A Case of Optic Atrophy and Visual Field Defect in Periventricular Leukomalacia
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 하부시야결손을 주소로 내원한 22세 여자환자에서 동반된 뇌실주위백질연화증 1예를 경험하였기에 이를 보고하고자 한다. 증례요약: 22세 여자 환자가 시력교정수술을 위해 방문한 개인안과에서 양안의 시신경 위축과 시야검사 후 양안 하부시야결손이 발견되어 정상안압녹내장으로 진단받고 의뢰되었다. 최대교정시력은 양안 1.0 이었고 안압은 양안 16 mmHg이었다. 양안의 유두함몰비는정상이었으나 이측 유두부에 시신경의 창백 소견이 관찰되었다. 흑백안저사진과 빛간섭단층촬영검사에서 상이측 망막신경섬유층 결손이 관찰되었다. 시야검사에서는 양안 하부시야결손이 나타났다. 출생시 재태기간은 34주, 출생체중은 1600그램으로 미숙아 및 저체중아 과거력이 있었고, 뇌자기공명영상검사에서 양측 뇌실주위백질연화증이 관찰되었다. 결론: 양안의 시신경 위축과 하부시야결손으로 정상안압녹내장으로 진단받았던 환자에서 뇌실주위백질연화증을 경험하였다. 저체중출생 또는 미숙아 과거력을 가지고 특이적 녹내장성 변화를 보이지 않는 시야 결손을 보이는 경우, 원인으로 안질환 이외의 뇌병변을고려해야 하고 뇌자기공명영상 검사가 진단에 도움이 될 수 있음을 알 수 있었다.
Abstract
Purpose: To report a case of visual field defect and optic atrophy in a patient with periventricular leukomalacia. Case summary: A 22-year-old woman was referred to our hospital for further glaucoma evaluation. She was diagnosed with normal tension glaucoma by her local ophthalmologist. Best corrected visual acuity and intraocular pressure were 1.0and 16 mm Hg in both eyes, respectively. Fundus examination showed a cup disc ratio of 0.36 in the right eye and 0.34 in the left eye. However, the optic disc had temporal pallor. Red-free photograph and optical coherence tomography showed supratemporal retinal nerve fiber layer atrophy. Visual field examinations revealed inferior visual field defect in both eyes. The patient was born at 34 weeks of gestation with a birth weight of 1600 g. Brain magnetic resonance imaging (MRI)showed periventricular leukomalacia. Conclusions: The author presents a case of periventricular leukomalacia with inferior visual field defect and optic atrophy in a patient who was previously diagnosed with glaucoma. If non-specific clinical features that differ from typical glaucomatous clinical features are observed in a patient with a history of prematurity, a brain MRI can aid the diagnosis.
참고문헌 (27)
- Miller SP, "Early brain injury in premature newborns detected with magnetic resonance imaging is associated with adverse early neurodevelopmental outcome", J Pediatr, 147, pp.609~616 (2005)
- Litt J, "Learning disabilities in children with very low birthweight: prevalence, neuropsychological correlates, and educational interventions", J Learn Disabil, 38, pp.130~141 (2005)
- Hernández-Cabrera MA, "Periventricular leukomalacia prevalence in premature newborn", Rev Med Inst Mex Seguro Soc, 47, pp.147~150 (2009)
- Liu J, "Periventricular leukomalacia in premature infants in mainland China", Am J Perinatol, 25, pp.535~540 (2008)
- Olsén P, "Magnetic resonance imaging of periventricular leukomalacia and its clinical correlation in children", Ann Neurol, 41, pp.754~761 (1997)
- Jacobson L, "Optic disc morphology may reveal timing of insult in children with periventricular leucomalacia and", or periventricular haemorrhage, 2003, pp.87, 1345~1349
- Fazzi E, "Visual-perceptual impairment in children with periventricular leukomalacia", Brain Dev, 26, pp.506~512 (2004)
- Brodsky MC, "Periventricular leukomalacia: an intracranial cause of pseudoglaucomatous cupping", Arch Ophthalmol, 119, pp.626~627 (2001)
- Allingham RR, "The clinical form of glaucoma. Shields’ textbook of glaucoma", pp.11~ (2011), Lippincott Williams & Wilkins
- Cioni G, "Cerebral visual impairment in preterm infants with periventricular leukomalacia", Pediatr Neurol, 17, pp.331~338 (1997)
- Brodsky MC, "Congenital optic disc anomalies, In Pediatric Neuro- Ophthalmology", pp.2~ (2010), Springer
- Fazzi E, "Cognitive visual dysfunctions in preterm children with periventricular leukomalacia", Dev Med Child Neurol, 51, pp.974~981 (2009)
- Park SJ, "Strabismus, amblyopia and refractory errors in patients with cerebral palsy", J Korean Ophthalmol Soc, 40, pp.2898~2903 (1999)
- Keith CG, "The significance of ocular morbidity in very-low-birthweight infants to the Australian health service", Aust J Ophthalmol, 11, pp.29~31 (1983)
- Khetpal V, "Cortical visual impairment: etiology, associated findings, and prognosis in a tertiary care setting", J AAPOS, 11, pp.235~239 (2007)
- Jacobson L, "Visual and perceptual characteristics, ocular motility and strabismus in children with periventricular leukomalacia", Strabismus, 10, pp.179~183 (2002)
- Jacobson L, "Nystagmus in periventricular leucomalacia", Br J Ophthalmol, 82, pp.1026~1032 (1998)
- Jacobson LK, "Periventricular leukomalacia: an important cause of visual and ocular motility dysfunction in children", Surv Ophthalmol, 45, pp.1~13 (2000)
- Brodsky MC, "Semiology of periventricular leucomalacia and its optic disc morphology", Br J Ophthalmol, 87, pp.1309~1310 (2003)
- Jacobson L, "Large cups in normal-sized optic discs: a variant of optic nerve hypoplasia in children with periventricular leukomalacia", Arch Ophthalmol, 115, pp.1263~1269 (1997)
- Brodsky MC, "Optic nerve hypoplasia. Clinical significance of associated central nervous system abnormalities on magnetic resonance imaging", Arch Ophthalmol, 111, pp.66~74 (1993)
- Lee DW, "Topographic measurement of the optic nerve head with confocal scanning laser tomography in normal third decade of Korean", J Korean Ophthalmol Soc, 40, pp.489~495 (1999)
- Minagawa K, "Possible correlation between high levels of IL-18 in the cord blood of pre-term infants and neonatal development of periventricular leukomalacia and cerebral palsy.", Cytokine, 17, pp.164~170 (2002)
- Mewasingh LD, "Motor strategies in standing up in leukomalacic spastic diplegia", Brain Dev, 24, pp.291~295 (2002)
- Flodmark O, "Periventricular leukomalacia : radiologic diagnosis", Radiology, 162(1 Pt 1), pp.119~124 (1987)
- 이영석, "신생아의 낭성 뇌실 주위 백질연화증: 순차적 초음파 소견과 신경학적 장애의 분석", 대한영상의학회지, 49(1), pp.57~62 (2003), 대한영상의학회
- 박현경, "미숙아에서의 저산소성 허혈성 뇌 손상: 뇌실주위백질연화증의 최근 동향", 대한주산의학회잡지, 20(2), pp.106~113 (2009), 대한주산의학회