양안 시력 저하를 보인 가역적 후두부 뇌병증 증후군 1예
A Case of Posterior Reversible Encephalopathy Syndrome with Bilateral Visual Impairment
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목적: 양안에서 발생한 피질 시각 장애가 경과 관찰 후 완전히 회복된 가역적 후두부 뇌병증 증후군의 1예를 경험하였기에 이를 보고하고자 한다. 증례요약: 46세 여자 환자가 당일 시작된 갑작스런 양안 시력 저하를 주소로 내원하였다. 환자는 10일 전 월경과다 및 자궁 탈출증으로 인한 빈혈로 보존적 치료를 받았고, 2일 전 자궁근종 절제술 시행 후 과다 출혈 및 빈혈 소견이 보여 수혈을 다시 받은 후에 갑자기 뿌옇게 보이는 증상을 호소하였다. 내원 당시 양안 최대교정시력은 모두 안전수동 10 cm였고, 양안 모두 동공의 대광반사는 정상이었으며 안저 검사상 좌안 이측에 일부 미세한 점출혈 소견 외에는 특이소견은 관찰되지 않았다. 빛간섭단층촬영 검사에서도 양안 모두 이상 소견은 없었다. 그러나 섬광 시유발전위 검사상 양안 모두 P100 진폭의 명백한 감소를 보였다. 뇌 자기공명영상 검사에서 양측두정-후두엽에 고신호 병변이 관찰되어 가역적 후두부 뇌병증 증후군으로 진단하고, 별다른 치료 없이 경과를 관찰하였다. 양안 시력이 점차 호전되는 양상으로 진단 후 16주째 경과 관찰 시 양안 모두 최대교정시력 1.0으로 회복되었고 시유발전위 검사에서도 양안 모두 P100 진폭이 회복된 결과를 나타내었다. 결론: 만성 빈혈 및 수혈 이후 다른 신경학적 증상 없이 양안 시력 저하 증상만을 주소로 내원한 환자에서 가역적 후두부 뇌병증의 빠른 진단하에 불필요한 치료 없이 경과 관찰만으로 시력은 완전히 회복되었다.
Abstract
Purpose: To report a case of recovery of bilateral cortical blindness in a patient with posterior reversible encephalopathy syndrome. Case summary: A 46-year-old female visited the ophthalmology department due to abrupt visual acuity decrease. Ten days earlier, she had received conservative management due to anemia caused by menorrhagia and uterine prolapse. She underwent a gynecological operation to remove a uterine myoma two days previously, and was given a blood transfusion postoperatively because of excessive bleeding. After the transfusion, she complained of acute blurred vision. Her best corrected visual acuity (BCVA) was hand motion 10 cm in both eyes. There were no abnormal specific findings except retinal dot hemorrhage at the temporal side in the left eye on fundus examination. Her pupillary light reflex was normal and optical coherence tomography examination was unremarkable in both eyes. However, flash visual evoked potential findings showed reduced P100 amplitude in both eyes and she was diagnosed with posterior reversible encephalopathy syndrome based on brain magnetic resonance imaging. After close observation without any treatment, the symptoms gradually improved. Finally, her BCVA recovered to 1.0 and P1 and P100 amplitudes were restored to normal range in both eyes at 16 weeks from the first diagnosis. Conclusions: A patient complained of bilateral visual loss without other neurological symptoms after chronic blood loss and blood transfusion. She recovered visual acuity completely with prompt diagnosis of posterior reversible encephalopathy syndrome and close observation only.
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