양안 복시로 나타난 도르래신경초종 1예
A Case of Trochlear Nerve Schwannoma Presenting with Binocular Diplopia
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목적: 신경섬유종증이 없는 환자에서 단안의 도르래신경에 국한되어 발생한 신경초종 1예를 경험하였기에 이를 보고하고자 한다. 증례요약: 58세 남자가 10일 전부터 갑자기 발생한 복시를 주소로 내원하였다. 프리즘교대가림검사, 안구운동검사, 빌쇼스키머리기울임검사 소견이 좌측상사근마비에 부합하였다. 고해상도 뇌자기공명영상검사에서 좌측 도르래신경이 뇌간의 외측을 지나가는 위치에서 앞뒤 길이 6 mm 크기의 소엽모양의 종괴를 형성하였고, 얇은 절편 조영증강 자기공명영상을 추가로 시행하여 도르래신경초종을 확인하였다. 프리즘안경 착용을 통해 복시가 호전되어 추가적인 치료 없이 경과관찰하기로 하였다. 결론: 성인에서 후천상사근마비로 인해 발생한 복시의 경우 도르래신경종양을 감별해야 한다.
Abstract
Purpose: To report a case of unilateral trochlear nerve schwannoma in a patient without neurofibromatosis. Case summary: A 58-year-old male presented with acute onset of diplopia which developed 10 days prior. Alternate prism cover test, ductions and versions and Bielschowsky three-step test were compatible with left superior oblique muscle palsy. High-resolution magnetic resonance imaging showed a 6-mm-sized lobulated mass in the cisternal segment of the left trochlear nerve passing lateral to the brainstem. An additional thin-section gadolinium-enhanced orbit magnetic resonance imaging showed definite enhancement in the entire portion of the lobulated mass, compatible with a trochlear nerve schwannoma. Diplopia was managed conservatively with prism glasses and regular follow-up examinations were recommended without further treatment. Conclusions: A trochlear nerve tumor should be considered in adults who develop diplopia associated with acquired superior oblique muscle palsy.
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