외상성 3, 4, 6번 단독뇌신경마비의 동반손상과 예후
Associated Injuries and Prognosis in Traumatic Isolated 3rd, 4th, and 6th Cranial Nerve Palsies
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목적: 외상 후 제3, 4, 6번 단독뇌신경마비로 진단된 환자에서 동반손상의 강도와 예후와의 관계를 알아보았다. 대상과 방법: 외상이 발생하고 제3, 4, 6번 단독뇌신경마비로 진단된 환자 39명 39안을 대상으로 외상의 원인 및 동반손상의 강도,마비의 정도 및 예후 등을 후향적으로 조사하였다. 결과: 제 4번 뇌신경마비가 19명(48.7%)으로 가장 많았고, 제 6번 뇌신경마비가 12명(30.8%), 제 3번 뇌신경마비가 8명(20.5%)이었다. 외상의 가장 흔한 원인은 제3, 4, 6번 뇌신경마비 모두 교통사고였다. 외상 시 의식소실, 두개 내 출혈, 두개안면골 골절, 경추손상,시신경손상이 동반되었는데, 3번 뇌신경마비가 가장 많은 손상이 동반되었으며, 마비의 정도 역시 가장 심하였다. 전체적인 회복률은46.2%였으며, 외상 시 두개 내 출혈이 동반되는 경우 낮은 회복률을 보였다. 신경별로는 3번 뇌신경이 25%, 4번 뇌신경이 47.4%,6번 뇌신경이 58.3%로 3번 뇌신경의 회복률이 가장 낮았다. 결론: 외상 후 제3, 4, 6번 단독뇌신경마비환자에서 두개 내 출혈이 동반되는 경우 예후가 좋지 않았다. 또한 신경별로는 3번 뇌신경마비가 동반손상이 많았고 마비정도가 심하였으며 예후도 좋지 않았다.
Abstract
Purpose: To analyze the relationship between prognosis and the severity of associated injuries in traumatic isolated 3rd, 4th and6th cranial nerve palsies. Methods: The records of 39 patients (39 eyes) who were diagnosed with isolated 3rd, 4th or 6th cranial nerve palsy followingtrauma were reviewed retrospectively to analyze the etiology of trauma, the degree of associated injuries, the degree of paralysis,and the prognosis. Results: The 4th cranial nerve was affected most frequently (19 patients, 48.7%), followed by the 6th nerve (12 patients, 30.8%)and the 3rd nerve (8 patients, 20.5%). Traffic accidents were the most frequent etiology of traumatic cranial nerve palsies. Lossof consciousness, intracranial hemorrhage, craniofacial fracture, c-spine injury, and optic nerve injury were among the mostcommon accompanying conditions. The 3rd cranial nerve was the most severely paralyzed and showed the highest number ofassociated injuries. The recovery rate of the all cranial nerve palsies was 46.2%. By nerve, the 3rd cranial nerve palsy showed thelowest recovery rate of 25%, followed by the 4th nerve at 47.4%, and the 6th nerve at 58.3%. Conclusions: The prognosis was worse in patients with intracranial hemorrhage, compared with those without intracranialhemorrhage. There was a higher average number of associated injuries and the degree of paralysis was more severe in 3rdnerve palsies.
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