허혈성 3, 4, 6번 단독 뇌신경마비환자의 위험인자 및 예후
Risk Factors and Prognosis of Isolated Ischemic 3rd, 4th, 6th Cranial Nerve Palsy
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목적: 허혈성 제3, 4, 6번 단독 뇌신경마비 환자의 위험인자를 분석하고 임상양상을 고찰하였다. 대상과 방법: 허혈성 제3, 4, 6번 단독 뇌신경마비로 진단된 환자 46명 46안을 대상으로 발병연령, 위험인자, 회복률 및 회복시간 등을후향적으로 분석하였다. 결과: 총 46명의 환자 중 3번 뇌신경마비군이 15명(32.6%), 4번 마비군이 15명(32.6%), 6번 마비군이 16명(34.8%)이었고 평균 발병연령은 64.9세였다. 고혈압, 당뇨, 고지혈증, 혈중 헤마토크릿 상승, 허혈성심질환, 좌심실비대, 흡연 등의 위험인자 중 고혈압을 가지고있는 환자가 30명(65.2%)으로 가장 많았다. 동반 위험인자는 3번 마비군이 평균 2.3 ± 0.5개를 가지고 있었고, 6번 마비군이 1.6± 1.1개, 4번 마비군이 1.4 ± 1.1개로 3번 마비군에서 좀 더 많은 위험인자가 동반되었다. 총 46명의 환자 중 42명(91.3%)이 회복되었으며 신경별 회복률의 차이는 없었다. 영상검사에서 두개내 이상 소견을 보였던 군(10.5 ± 2.9주)이 이상 소견이 없는 군(7.5 ± 5.1주)보다 회복기간이 늦었다. 결론: 허혈성 원인에 의한 3, 4, 6번 단독 뇌신경마비 환자에서 전체적인 회복률은 높았지만, 영상검사에 이상 소견이 있는 경우 회복시간이 오래 걸렸다. 또한 3번 뇌신경마비가 여러 위험인자를 동반하는 특징이 있었다.
Abstract
Purpose: To investigate the clinical features and risk factors of ischemic third, fourth, sixth cranial nerve palsy. Methods: Retrospectively, we reviewed the medical records of 46 eyes of 46 patients who were diagnosed with ischemic third,fourth, sixth nerve palsy alone such as age of onset, risk factors, recovery rate and recovery time. Results: The mean age of onset was 64.9 years. Of the 46 patients, 15 patients (32.6%) in third cranial nerve palsy group, 15 patients(32.6%) in fourth cranial nerve palsy group, 16 patients (34.8%) in sixth cranial nerve palsy group. The risk factor of hypertensionin 30 patients (65.2%) was the most common than other risk factors such as diabetes, hyperlipidemia, elevated bloodhematocrit, ischemic heart disease, left ventricular hypertrophy, smoking. The mean number of risk factors was 2.3 ± 0.5 in thirdcranial nerve palsy group, 1.6 ± 1.1 in sixth cranial nerve palsy group, 1.4 ± 1.1 in fourth cranial nerve palsy group. Of the 46 patients,42 patients (91.3%) were recovered. There was no significant difference in recovery rate by cranial nerve palsy. Recoverytime of intracranial abnormalities group (10.5 ± 2.9 weeks) in brain imaging study was late as compared with that of no intracranialabnormalities group (7.5 ± 5.1 weeks). Conclusions: The overall recovery rate of isolated ischemic third, fourth, sixth cranial nerve was high. But if there are intracranialabnormalities in imaging study, it took a long time to recover. Also ischemic third cranial nerve palsy had multiple risk factorscharacteristically.
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