섬유근형성이상 환자에서 발생한 부분 눈돌림신경마비

Incomplete Oculomotor Nerve Palsy Caused by Internal Carotid Artery Giant Aneurysm with Fibromuscular Dysplasia

Article information

J Korean Neurol Assoc. 2019;37(2):216-217
Publication date (electronic) : May 1, 2019
doi : http://dx.doi.org/10.17340/jkna.2019.2.23
aDepartment of Neurology and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
bDepartment of Neurology, Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
이상학a,b, 이학승,a,b
a원광대학교 의과대학 신경과학교실 및 원광의과학연구소
b원광대학교병원 전북권역심뇌혈관센터 신경과
Address for correspondence: Hak Seung Lee, MD Department of Neurology and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, 460 Iksan-daero, Iksan 54538, Korea Tel: +82-63-859-1410 Fax: +82-63-842-7379 E-mail: nmgom@wku.ac.kr
*

This study was supported by Wonkwang Grant in 2018.

received : December 12, 2018 , rev-recd : March 15, 2019 , accepted : March 15, 2019 .

45세 여자가 일주일 전에 발생한 어지럼과 두통으로 왔다. 환자는 섬유근형성이상(fibromuscular dysplasia)으로 진단받은 후 우측 콩팥동맥 협착으로 피부경유혈관경유관풍선혈관성형술(percutaneous transluminal balloon angioplasty)을 시행받은 과거력이 있었다(Fig. A). 신경학적 진찰에서 우측 눈 안검하수와 우측 눈의 동공이 좌측에 비해 확장되어 있는 동공부등(anisocoria) 및 동공반사가 우측에서 느리게 관찰되었다(Fig. B). 안구운동검사에서는 우측 눈의 상방주시가 불가능한 상태였다(Fig. B). 뇌 자기공명혈관조영 영상에서 우측 경동맥에 2 cm 크기의 뇌동맥류와 함께 좌측 경동맥, 척추동맥에서도 뇌동맥류가 확인되었다(Fig. C).

Figure.

(A) Renal artery angiography showed stenotic lesion (string of beads sign) of the right renal artery (arrow). (B) Note the right upper eyelid ptosis and pupil dilatation. Nine positions of gaze. There is limitation of elevation of the right eye. (C) MRA showed aneurysms in the intra-cavernous part of both internal carotid artery and right vertebral artery (arrow). Axial T1-enhanced image showed aneurysms on cavernous sinus (arrow). MRA; magnetic resonance angiography.

섬유근형성이상은 신장 혈관을 침범하여 고혈압을 일으키고, 드문 경우에 두개 내 혈관을 침범하여 뇌경색, 뇌출혈, 뇌동맥류를 발생시킨다[1]. 해부학적으로 경동맥과 눈돌림신경은 해면정맥동에서 가깝게 위치하여, 뇌동맥류가 물리적 압박으로 눈돌림신경분할마비를 일으킬 수 있다. 이번 증례에서 눈돌림신경 위분지를 침범하였고, 비슷한 증례도 있다[2].

References

1. Lee DK, Heo SH, Kwon SH, Park KC, Ahn TB, Yoon SS, et al. Cerebral infarction in a young female patient with renovascular hypertension caused by fibromuscular dysplasia. J Korean Neurol Assoc 2010;28:326–328.
2. Bhatti MT, Eisenschenk S, Roper SN, Guy JR. Superior divisional third cranial nerve paresis: clinical and anatomical observations of 2 unique cases. Arch Neurol 2006;63:771–776.

Article information Continued

Figure.

(A) Renal artery angiography showed stenotic lesion (string of beads sign) of the right renal artery (arrow). (B) Note the right upper eyelid ptosis and pupil dilatation. Nine positions of gaze. There is limitation of elevation of the right eye. (C) MRA showed aneurysms in the intra-cavernous part of both internal carotid artery and right vertebral artery (arrow). Axial T1-enhanced image showed aneurysms on cavernous sinus (arrow). MRA; magnetic resonance angiography.