청소년기에 발생한 특발 단안 외향신경마비 1예
A Case of Idiopathic Unilateral Abducens Nerve Palsy in an Adolescent Patient
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목적: 청소년기에 급성으로 발생한 특발 단안 외향신경마비 1예의 임상양상 및 치료경과에 대해 보고하고자 한다. 증례요약: 평소 건강하였던 14세 남자 환아가 내원 당일 기상 시 발생한 양안 수평복시를 주소로 본원에 내원하였다. 외상력, 백신접종력이나 감염성질환 등의 병력과 다른 신경학적 증상은 없었으며, 양안 교정시력은 20/20으로 전안부와 안저검사상 이상소견은 없었다. 교대프리즘가림검사상 정면주시 시 6 prism diopter (PD) 내사시와 안구운동 검사에서 -1 정도의 좌안 외전장애가 관찰되었다. 1주 뒤 정면 주시 시 20PD 내사시 및 좌안 외전장애가 -3.5 정도로 진행하는 양상이 관찰되어 뇌자기공명영상과 혈청학적 검사를 시행하였으나 특이소견이 관찰되지 않아 특발 단안 외향신경마비로 진단하였다. 고용량 스테로이드 정맥투여를 시행하고 5일 뒤 외전장애가 호전되기 시작하였고, 5주 후에는 복시 및 좌안 외전장애가 완전히 소실되었으며 1년 후까지 재발소견은 관찰되지 않았다. 결론: 청소년기에 특발 단안 외향신경마비가 발생하여 진행하는 임상경과를 보인 환자에서 고용량 스테로이드를 투여하여 단기간에 복시가 완전소실된 1예를 보고하는 바이다.
Abstract
Purpose: To report a case of idiopathic unilateral abducens nerve palsy in an adolescent patient. Case summary: A healthy 14-year-old boy presented with binocular horizontal diplopia that started that same day. He did not have any history of trauma, vaccination or infectious disease and showed no other neurological signs. The best corrected visual acuity of both eyes was 20/20. Slit lamp and fundus examinations revealed no other abnormalities. On the alternative prism cover test, he had 6 prism diopter (PD) esotropia with -1 degree abduction limitation in the left eye. After 1 week, the abduction limitation in the left eye was progressed to -3.5 degrees, so we performed brain imaging. The brain magnetic resonance imaging (MRI) and systemic evaluation (serologic test, cerebrospinal fluid examination) were normal therefore, we suspected idiopathic unilateral abducens nerve palsy. Thus, intravenous steroid injection was started, and the patient was partially recovered after 5 days of treatment. At 5 weeks after presentation, diplopia and abduction limitation in the left eye were completely resolved, and recurrence was not found during the 1 year of follow-up. Conclusions: We report a case of progressive idiopathic unilateral abducens nerve palsy in an adolescent which has resolved completely after intravenous steroid treatment in a short period.
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