급성 단독 눈운동 뇌신경마비 환자의 조기 뇌영상검사 결과 분석
Analysis of Early Neuroimaging Results in Patients with Acute Isolated Ocular Motor Nerve Palsy
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목적: 급성 3, 4, 6번 단독 뇌신경마비 환자에서 조기에 시행한 뇌영상검사의 유용성을 알아보고자 하였다. 대상과 방법: 50세 이상에서 급성 단독 3, 4, 6번 뇌신경마비가 발생한 환자들을 대상으로 증상 발생 1개월 이내에 뇌영상검사를 시행한 후 이상 소견이 발견되는 빈도, 이상 소견의 종류 등을 알아보았다. 또한 전체 환자들을 이상 소견이 발견된 환자군과 허혈성 3, 4, 6번 뇌신경마비로 진단된 환자군으로 구분하여 임상양상에 차이가 있는지 분석하였다. 결과: 총 55명의 환자들 중 뇌영상검사에서 이상 소견이 발견된 환자는 9명으로 빈도는 16.4%였다. 6번 뇌신경환자 26명 중 4명(15.4%)에서 뇌종양 2예, 뇌혈관압박 1예, 목동맥해면굴샛길 1예가 각각 발견되었고, 4번 뇌신경 환자 19명 중 2명(10.5%)에서 마비안의 상사근 위축이 발견되었다. 3번 뇌신경 환자 10명 중에서는 3명(30.0%)에서 이상 소견이 발견되었는데, 뇌하수체졸중 1예, 후교통동맥류 1예, 뇌혈관압박 1예가 각각 발견되었다. 결론: 급성 단독 3, 4, 6번 뇌신경마비 환자에서 조기에 뇌영상검사를 시행하는 것은 감별진단과 환자에게 치명적일 수 있는 질환을 배제하는 데에 도움이 될 것으로 생각된다.
Abstract
Purpose: To evaluate the efficacy of early neuroimaging in patients with acute isolated 3rd, 4th, and 6th nerve palsy. Methods: Neuroimaging tests were performed in patients >50 years old with acute isolated 3rd, 4th, and 6th nerve palsy. The frequencies and types of abnormal findings were evaluated. All patients were divided into ischemic and non-ischemic groups and differences in clinical characteristics between groups were analyzed. Results: Of the 55 patients, nine (16.4%) had abnormal findings on brain imaging. Among 26 patients with 6th nerve palsy, four (15.4%) were found to have a cause including brain tumor, cerebrovascular compression, carotid cavernous fistula. Superior oblique muscle atrophy was found in two of 19 patients (10.5%) with 4th nerve palsy. Three of 10 patients (30%) with 3rd nerve palsy had abnormal findings and there were cases of pituitary apoplexy, posterior communicating, and cerebrovascular compression. Conclusions: In patients with acute isolated oculomotor paralysis, early neuroimaging tests play an important role in differential diagnosis and evaluation of causes that may lead to mortality.
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