눈벌림 마비의 임상 양상 및 경과
Clinical Characteristics and Course in Divergence Paralysis
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목적: 눈벌림 마비의 임상특성에 대해 밝혀 이 질환에 대한 이해를 높이고자 하였다. 대상과 방법: 후향적으로 의무기록을 조사하여 6개월 이상 경과 관찰한 눈벌림 마비 환자를 선별하였다. 이들을 대상으로 발생양상,경과, 신경학적 및 영상학적 검사 등을 포함한 임상양상에 대하여 조사하였다. 결과: 총 15명의 환자가 포함되었고 평균 연령은 55.6세였다. 13명은 급성 발병하였으며, 2명은 서서히 발병하였다. 초진 시 원거리에서는 4-14 프리즘디옵터(PD) (평균 8 PD)의 내사시, 근거리에서는 6 PD의 외사위에서 10 PD의 내사위(평균 1.2 PD의 내사위)를 보였다. 추적관찰 중 눈벌림 마비와 연관된 다른 신경학적 질환이 발생하지 않았다. 일차성 눈벌림 마비 환자 13명 중 11명은 같은 도수의프리즘 안경에 지속적으로 의존하였다. 이차성 눈벌림 마비 환자 2명은 모두 원인질환이 호전되면서 원거리 복시가 소실되었다. 결론: 눈벌림 마비는 대부분에서 신경학적 이상이 동반되지 않았고 급성으로 발병하였다. 일차성 눈벌림 마비는 장기적으로 지속되는경과를 보였지만, 이차성 눈벌림 마비는 원인 질환이 회복되면서 조기에 회복되는 경과를 보였다.
Abstract
Purpose: To improve the understanding of divergence paralysis by identifying its clinical characteristics. Methods: We performed a retrospective chart review analysis of patients diagnosed with divergence paralysis that were followedup for at least 6 months. Clinical features, including disease onset, course, neurological examinations, and imaging studies wereevaluated. Results: Fifteen patients were included in the present study and the average age was 55.6 years. Thirteen patients had an acuteonset and 2 had an insidious onset. The initial distance deviation ranged from 4 to 14 prism diopters (PD) of esotropia (mean, 8PD esotropia) and near deviation ranged from 6 PD exophoria to 10 PD esophoria (mean, 1.2 PD esophoria). None of the patientsdeveloped additional neurological disorders associated with divergence paralysis during the follow-up period. Eleven of 13patients with primary divergence paralysis continued to depend on the prism glasses with the same diopters. In the 2 patientswith secondary divergence paralysis, distant diplopia disappeared as the underlying disease improved. Conclusions: In our study, the majority of divergence paralysis was not associated with neurological diseases and the patientshad an acute onset. Primary divergence paralysis lasted for an extended period. However, secondary divergence paralysis wasresolved quickly as the underlying disease improved.
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