소아 가성뇌종양에 의한 양안 유두부종 및 시야장애 1예
A Case of Bilateral Papilledema and Visual Field Defect in Pediatric Idiopathic Intracranial Hypertension
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목적: 소아 가성뇌종양에 의한 양안 유두부종 및 시야장애를 동반한 환아 1예를 경험하였기에 이를 보고하고자 한다. 증례요약: 5세 정상 체중 여자 환아가 3주 전부터 발생한 두통, 구토 증상을 주소로 소아과에 입원하였다. 입원 후 환아는 복시를호소하였다. 나안시력 우안 0.3, 좌안 0.8이었고 교대프리즘가림검사에서 35 prism diopter 내사시와 양안 -2 외전 장애를 보였으며안저 검사 시 양안 유두부종 및 유두 경계부의 출혈 소견을 보였다. 영상학적 검사에서 특이병변이 없고 두통, 구토 등의 증상이 있고양안 유두부종과 내사시가 있으며 신경학적 검사에서 정상인 것으로 보아 소아 가성뇌종양으로 진단하였다. 시야검사에서 우안 MD -14.15 dB, 좌안 MD -16.58 dB이었고 전반적으로 감도가 저하되어 있었다. 치료로 acetazolamide (DiamoxⓇ)를 30일간 복용하였다. 내원 44일째부터 양안 유두 경계부의 출혈 소견과 혈관의 구불거림이 감소하였고 나안시력은 우안 1.0, 좌안 0.9로 호전되었다. 근거리와 원거리 내사시각은 5 PD로 감소하였으며 시야검사도 우안 MD -4.83dB, 좌안 -5.24dB로 호전되었다.
Abstract
Purpose: To report a case of bilateral papilledema and visual field defect in pediatric idiopathic intracranial hypertension. Case summary: The 5-year-old female patient was admitted to the hospital, complaining of headache and vomiting of 3weeks duration. After admission, she complained of diplopia. The uncorrected visual acuity was 0.3 in the right eye and 0.8in the left. An alternative prism cover test showed approximately 35 PD esotropia, with a -2 abduction limitation of both eyes. Fundus examination showed bilateral papilledema and peripapillary retinal hemorrhages. No abnormality was found in the MRI and CT, symptoms of headache, vomiting, bilateral papilledema, and esotropia with normal neurologic examination. Therefore, she was diagnosed with pediatric idiopathic intracranial hypertension. In Humphrey visual field test, MD was -14.15 dB in right and -16.58 dB in the left eye. Also, the general sensitivity of visual field decreased. Acetazolamide (Diamox®) was given orally for 30 days. Forty-four days after the initial visit, peripapillary retinal hemorrhages and vessel tortuosity decreased. Furthermore, visual acuity improved to 1.0 in the right eye and 0.9 in the left. The esotropia reduced to 5 PD, and MD improved to -4.83 dB in the right eye and -5.24 dB in the left.
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