뇌하수체졸중환자에서 발생한 단독 양측 동안신경마비

• 영문명: Pituitary Apoplexy Presenting as Isolated Bilateral Oculomotor Nerve Palsy
• 발행기관: 대한안과학회
• 저자명: 조희정(Heejung Cho) 송영진(Young Jin Song) 류원열(Won Yeol Ryu)
• 간행물 정보: 『대한안과학회지』Ophthalmological Society,volume60,number10, 1010~1014쪽, 전체 5쪽
• 주제분류: 의약학 > 기타의약학
• 파일형태: PDF
• 발행일자: 2019.10.30

국문 초록

목적: 뇌하수체졸중으로 인해 발생한 양안 단독 동안신경마비 1예를 보고하고자 한다. 증례요약: 46세 남자가 6일 전부터 발생한 양안 눈꺼풀처짐 및 갑작스러운 극심한 두통으로 방문하였다. 12년 전에 외상으로 두부수술 및 양안 유리체절제술을 받았던 병력이 있어서 양안 시력이 좋지 않았던 환자로, 첫 내원 시 교정시력은 우안 안전수지, 좌안 0.05였다. 좌측 동공이 산대되어 있었고 우측은 정상이었다. 눈운동검사에서 양안 모두 내전, 상전, 하전 장애가 관찰되어 양안 동안신경마비로 의심되었다. 뇌 자기공명영상에서 뇌하수체졸중으로 진단되어 입원 후 메틸프레드니솔론 1.0 g 전신 정맥주사 치료를 하였고, 뇌항해기법장치 경접형골 접근법(navigation guided transsphenoidal approach)을 이용한 외과적 감압술(surgical decompression) 및 흡인생검을 시행하였다. 병리검사 결과, 뇌하수체샘종으로 확진되었다. 술 후 3일째에 우안 안구운동장애는 모두 호전되었고, 술 후 4개월째에 양안 눈 운동이 완전히 호전되었다. 결론: 뇌하수체졸중으로 발생한 단독 양안 동안신경마비는 드물고 국내 최초의 보고이며, 수술 치료 후 빠른 완전 회복을 보였기에 보고하고자 한다.

영문 초록

Purpose: To report a case of pituitary apoplexy presenting as isolated bilateral oculomotor nerve palsy. Case summary: A 46-year-old male presented with bilateral ptosis and acute severe headaches for 6 days. He underwent head surgery and bilateral vitrectomy 12 years prior to his visit because of ocular and head trauma. He mentioned that previous visual acuities in both eyes were not good. The initial corrected visual acuity was finger counting in the right eye and 20/500 in the left eye. Ocular motility testing revealed the limitation of adduction, supraduction, and infraduction with complete bilateral ptosis in both eyes, and his left pupil was dilated. He was diagnosed with an isolated bilateral oculomotor nerve palsy. Magnetic resonance imaging indicated pituitary gland hemorrhage with a tumor, which was suspicious of pituitary apoplexy. The patient was treated intravenous with 1.0 g methylprednisolone to prevent the corticotropic deficiency. In addition, he underwent surgical decompression using a navigation-guided transsphenoidal approach and aspiration biopsy. He was confirmed with pituitary adenoma using a pathological examination. The patient’s ocular movements began to dramatically improve by the third day postoperatively. At 4 months postoperative follow-up, his ocular movement and double vision were completely recovered. Conclusions: This was a rare case of pituitary apoplexy with bilateral isolated oculomotor nerve palsy, which was the first report in the Republic of Korea. A full recovery was achieved after early surgical treatment.

목차

Abstract

증례보고

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국문초록

키워드

Cranial nerve palsy Oculomotor nerve disease Oculomotor nerve palsy Pituitary adenoma Pituitary apoplexy