허혈시신경병증 및 시신경교종과 유사한 소견을 보인 시신경염
Optic Neuritis Mimicking Ischemic Optic Neuropathy and Optic Glioma
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목적: 허혈시신경병증 및 시신경교종과 유사한 소견을 보인 시신경염 환자 1예를 보고하고자 한다. 증례요약: 63세 남자가 1달 전 갑자기 발생한 우안의 무통성 시력 저하를 주소로 내원하였다. 구심성동공운동장애 및 시신경 창백을동반한 하측 시야 결손 소견을 보여 임상적으로는 허혈시신경병증이 의심되었으나, 뇌 및 안와 자기공명영상에서 우측 시신경의 두개내 부위에 국소적 조영 증가 소견이 보여 두개 내 시신경교종으로 추정되었고 신경외과에서는 시신경 절제술을 권유하였다. 하지만저자들은 비전형적인 시신경염의 가능성이 있다는 판단하에 비침습적 치료인 고용량 메틸프레드니솔론(methylprednisolone) 전신투여를 먼저 시행하였다. 치료 직후 우안 나안 시력은 0.1에서 0.3으로 호전되었고, 시야결손 및 주관적 증상이 호전되는 소견을 보였다. 치료 8개월 후 재 시행한 뇌 및 안와 자기공명영상에서 시신경교종으로 의심되었던 국소 조영 증강 병변이 소실 되어, 최종적으로시신경염으로 진단할 수 있었다. 결론: 시신경염은 비전형적 임상양상을 보일 수 있고, 종종 시신경교종과 감별하기 힘든 경우가 있으므로, 이에 대한 충분한 고려와신중한 치료적 접근이 필요할 것으로 생각한다.
Abstract
Purpose: To report a case of optic neuritis difficult to differentiate from ischemic optic neuropathy and optic nerve glioma. Case summary: A 63-year-old male visited our clinic because of a sudden painless decrease in visual acuity in his right eye. Hehad a relative afferent pupillary defect and inferior altitudinal scotoma with disc pallor in his right eye. Ischemic optic neuropathywas suspected based on these clinical observations. However, a focal enhancing lesion was found in the intracranial portion ofthe right optic nerve on gadolinium-enhanced T1-weighted MRI. The radiologist’s report revealed right intracranial optic glioma. Optic neurectomy was planned in accordance with the suspicion for optic glioma. However, a systemic mega-dose methylprednisolonetherapy which is relatively less invasive was performed first based on the decision that optic neuritis should be distinguishedfrom optic nerve glioma. The patient was hospitalized and 1 gram of methylprednisolone was injected intravenouslydaily for 3 days. The patient's visual acuity in the right eye improved from 0.1 before treatment to 0.3 after treatment. MRI scansat 8 months after steroid treatment showed disappearance of the previously enhanced lesion suspicious for optic glioma with developedatrophic change. The patient was finally diagnosed with optic neuritis based on these results. Conclusions: Careful differential diagnoses and therapeutic approaches to possible diseases are necessary because optic neuritiscan manifest as a variety of clinical entities and imaging findings.
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