양측 시상경색에 의한 양하전근 마비
A Case of Double Depressor Palsy due to Bilateral Thalamic Infarction
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목적: 양측 시상 경색으로 인한 우안의 양하전근 마비 1예를 경험하였기에 이를 보고하고자 한다. 증례요약: 47세 남자 환자가 자고 일어난 후 갑자기 발생한 복시를 주소로 내원하였다. 환자는 심방세동 및 승모 판막 폐쇄 부전,대동맥 판막 폐쇄 부전증이 있었고, 1년 전 비장 경색 병력이 있었다. 제일눈위치에서 우상사시와 외사시가 관찰되었고, 눈운동 검사상 우안 정위시의 하전, 내전시의 하전, 외전시의 하전이 모두 되지 않았고, 다른 범위에서는 정상적인 눈운동을 보였다. 좌안의 눈운동은 정상이었다. 동공 반응 및 눈모음 반응은 정상이었으며, 안진은 관찰되지 않았다. 환자는 우안 양하전근마비로 진단받고, 원인질환 감별을 위한 뇌 자기공명영상(MRI)상 좌측 시상에 오래된 경색이 관찰되었고. 확산 자기공명영상에서 우측 시상에 급성 경색을확인하였다. 환자에게 복용 중이던 와파린(Warfarin)을 2 mg에서 5 mg으로 증량하도록 하고, 실로스타졸(Cilostazol) 75 mg을 하루2회 복용하도록 하였다. 7주 후 환자의 복시 증상은 완전히 회복되었다. 결론: 양하전근 마비는 매우 드문 질환으로, 양측 시상 경색에 의해 발생할 수 있다.
Abstract
Purpose: We report a rare case of double depressor palsy after bilateral thalamus infarction. Case summary: A 47-year-old male presented with complaints of diplopia upon awakening. He had atrial fibrillation, mitral valveregurgitation, aortic valve regurgitation and a history of spleen infarction 1 year prior. His right eye was hypertrophic and right eyedowngaze was limited unilaterally of equal degree in adduction and abduction. Right eye horizontal and upward movementswere intact. Left eye movement was intact in all directions. Pupillary light reflex response and convergence test were normal. Nystagmus was not observed. The patient was diagnosed with double depressor palsy of the right eye. Magnetic resonanceimaging (MRI) and magnetic resonance angiography (MRA) of the brain showed an old infarction of the left thalamus and diffusionMRI showed acute infarction of the right thalamus. The patient's daily warfarin dose was 2 mg and was increased to 5 mgwith cilostazol 75 mg two times a day. Seven weeks later, the patient's ocular movement revealed near normal muscle actionand, subjectively, the patient was diplopia-free. Conclusions: Double depressor palsy is a extremely rare disease and can be caused by bilateral thalamic infarction.
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