외상목동맥해면굴샛길의 색전술 후 지연 발생한 한 눈 가돌림신경마비와 호너증후군
Delayed Onset Abducens Nerve Palsy and Horner Syndrome after Treatment of a Traumatic Carotid-cavernous Fistula
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목적: 외상목동맥해면굴샛길(traumatic carotid cavernous fistula)의 색전술 후 지연 발생한 가돌림신경마비(abducens nerve palsy) 와 호너증후군(Horner syndrome)을 보고한다. 증례요약: 68세 여자가 서서히 심해진 좌안 눈꺼풀처짐과 수평두눈복시로 왔다. 10년 전 교통사고로 좌측 외상목동맥해면굴샛길이발생하여 색전술을 시행받았으며, 치료 결과는 좋았다고 했다. 시술 6년 뒤부터 서서히 좌안 눈꺼풀처짐이 생겼으며, 이후 복시도발생했다고 한다. 좌안은 눈꺼풀처짐과 함께 동공이 축동되었으며, 어두운 조명에서 동공부등은 더 심해졌다. 안구운동검사에서 정면주시 시 30프리즘디옵터의 내사시와 좌안 -4의 가쪽운동장애 소견을 보였다. 뇌 자기공명영상과 자기공명혈관조영술에서 목동맥해면굴샛길의 재발을 의심할 소견은 없었다. 6개월 동안의 경과 관찰에서 내사시의 변화는 없었다. 사시수술을 시행하였고, 복시는 호전되었다. 결론: 목동맥해면굴샛길의 색전술 후 한눈 가돌림신경마비와 호너증후군이 지연 발생할 수 있다. 지연 발생한 뇌신경마비가 자연 호전을 보이지 않으면, 적극적인 사시수술의 시행을 고려할 수 있다.
Abstract
Purpose: We report a patient with delayed-onset abducens nerve palsy and Horner syndrome after endovascular treatment of traumatic carotid-cavernous fistula (CCF). Case summary: A 68-year-female visited our ophthalmic department complaining of gradual-onset ptosis of the left eye and horizontal diplopia. She had undergone endovascular treatment to treat left-sided traumatic CCF after a car accident 10 years before; she had been told at that time that the treatment outcome was favorable. The left-sided ptosis gradually developed 6 years after the procedure, accompanied by diplopia. The left eye exhibited miosis and the extent of anisocoria increased in dim light. An extraocular examination revealed 30 prism diopters of left esotropia in the primary gaze and a -4 abduction limitation of the left eye. CCF recurrence was suspected; however, magnetic resonance imaging with magnetic resonance angiography of brain did not support this. The esotropia did not improve during the 6-month follow-up and strabismus surgery was performed. Conclusions: Delayed-onset abducens nerve palsy and Horner syndrome can develop even after successful endovascular treatment of CCF. Strabismus surgery should be considered in patients whose diplopia does not spontaneously improve.
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