눈분절 속목동맥자루에 의한 가돌림신경마비 1예
Abducens Nerve Palsy Caused by the Ophthalmic Segment of an Internal Carotid Artery Aneurysm
0
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
목적: 급성으로 발생한 수평복시 환자에서 눈분절(ophthalmic segment) 속목동맥자루(internal carotid artery aneurysm)에 의한 가돌림신경마비(abducens nerve palsy)를 진단하고, 혈관 내 코일 색전술로 좋은 치료 결과를 얻었기에 이를 보고하고자 한다. 증례요약: 이전의 특이 과거력이 없는 59세 여자가 10일 전 갑자기 발생한 수평복시로 내원하였다. 시력은 양안 20/20이었고, 동공반응검사에서는 정상소견을 보였다. 안구운동검사에서 정면 주시 시 35프리즘디옵터(prism diopters, PD)의 내사시와 좌안 -4의 가쪽운동장애 소견을 보였다. 1달 전부터 이전에 없었던 측두부의 간헐적인 두통과 좌안 눈뒤통증이 있었다. 뇌자기공명혈관조영술에서 좌측 속목동맥의 눈분절(ophthalmic segment)의 돌출 병변을 확인하였고, 동맥자루로 의심되어 환자를 신경외과로 의뢰하였다. 환자는 뇌혈관조영술을 통해 좌측 속목동맥의 눈분절 동맥자루로 진단되었고, 코일 색전술을 시행받았다. 시술 후 3개월째 환자의 복시는 호전되었고, 정면 주시에서 정위 및 가쪽안구운동의 제한 소견도 없었다. 결론: 수평복시를 호소하는 환자에서 눈분절 속목동맥자루는 가돌림신경마비의 원인으로 고려될 수 있고, 혈관 내 코일 색전술을 통해서 좋은 결과를 얻을 수 있음을 확인하였다. 가돌림신경마비의 적절한 치료를 위해 원인감별이 중요하며, 허혈 이외의 원인이 의심되는 경우는 적극적인 뇌영상검사의 시행을 고려해야 한다.
Abstract
Purpose: To report a case of isolated abducens nerve palsy caused by the ophthalmic segment of an internal carotid artery (ICA) aneurysm which improved after endovascular coil trapping. Case summary: A 59-year-old female visited the ophthalmology department for a sudden onset of horizontal diplopia for 10 days. The best corrected visual acuity was 20/20 in both eyes. The pupils showed normal response to light and near stimulation in both eyes. The extraocular examination showed 35 prism diopters left esotropia at primary gaze and –4 abduction limitation of the left eye. The patient suffered intermittent headaches in the left temporal area and left retrobulbar pain for 1 month. Magnetic resonance imaging with magnetic resonance angiography of the brain was performed. A focal protruding lesion of the left ICA suggested an aneurysm. The patient consulted with the neurosurgery department. The left ophthalmic segment of the ICA aneurysm was confirmed by transfemoral cerebral angiography and treated with coil placement and the patient showed gradual improvement after the procedure. Three months after the procedure there was no diplopia. The patient showed orthotropia at primary gaze without abduction limitation. Conclusions: Isolated abducens nerve palsy can be caused by the ophthalmic segment of an ICA aneurysm, which should be considered in the differential diagnosis of ocular motility disorders. The disorder improved with coil replacement treatment. Differential diagnosis as a cause of abducens nerve palsy is important for prompt and appropriate treatment. Neuroimaging should be considered in patients with isolated abducens nerve palsy with a non-ischemic origin.
참고문헌 (15)
- Miller NR, "Walsh and Hoyt's Clinical Neuro-Ophthalmology: the essentials, 3rd ed.", pp.361~369 (2016), Wolters Kluwer
- 전찬, "6번 뇌신경마비의 원인과 자연 경과", 대한안과학회지, 47(11), pp.1776~1780 (2006), 대한안과학회
- Kline LB, "Neuro-Ophthalmology Review Manual, 7th ed.", pp.83~122 (2013), SLACK
- Hahn CD, "Giant cavernous carotid aneurysms: clinical presentation in fifty-seven cases", J Neuroophthalmol, 20, pp.253~258 (2000)[DOI]
- Mangat SS, "Horner's syndrome and sixth nerve paresis secondary to a petrous internal carotid artery aneurysm", Semin Ophthalmol, 26, pp.23~24 (2011)[DOI]
- Myeong-Jin OH, "Serpentine Cavernous Aneurysm Presented with Visual Symptoms Improved by Endovascular Coil Trapping", Journal of Cerebrovascular and Endovascular Neurosurgery, 18(4), pp.379~384 (2016), 대한뇌혈관외과학회[DOI]
- 박재영, "압박시신경병증으로 발현된 내경동맥의 미파열성 거대동맥류", 대한안과학회지, 53(9), pp.1368~1371 (2012), 대한안과학회
- Stiebel-Kalish H, "Presentation, natural history, and management of carotid cavernous aneurysms", Neurosurgery, 57, pp.850~857 (2005)
- Penchet G, "Collaborative retrospective multicentre series of giant intracavernous carotid aneurysms", Neurochirurgie, 61, pp.366~370 (2015)[DOI]
- Markwalder TM, "Acute painful cavernous sinus syndrome in unruptured intracavernous aneurysms of the internal carotid artery. Possible pathogenetic mechanisms", J Clin Neuroophthalmol, 3, pp.31~35 (1983)
- Nguyen DQ, "Recurrent isolated sixth nerve palsy secondary to an intracavernous carotid artery aneurysm", Eye (Lond), 20, pp.1416~1417 (2006)[DOI]
- Biousse V, "Neuro-Ophthalmology Illustrated, 2nd ed.", pp.321~465 (2016), Thieme
- Pane A, "The Neuro-Ophthalmology Survival Guide, 2nd ed.", pp.169~239 (2017), Elsevier
- Patel BM, "Endovascular treatment of supraclinoid internal carotid artery aneurysms", Neurosurg Clin N Am, 25, pp.425~435 (2014)[DOI]
- van Rooij WJ, "Unruptured large and giant carotid artery aneurysms presenting with cranial nerve palsy: comparison of clinical recovery after selective aneurysm coiling and therapeutic carotid artery occlusion", AJNR Am J Neuroradiol, 29, pp.997~1002 (2008)[DOI]