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J Korean Neurol Assoc > Volume 36(4); 2018 > Article
상방수평시야결손으로 발현된 가역적후뇌병증

신경영상

J Korean Neurol Assoc 2018; 36(4): 413-414.

Published online: November 1, 2018

DOI: https://doi.org/10.17340/jkna.2018.4.36

상방수평시야결손으로 발현된 가역적후뇌병증

전승호a, b, c, 신현준a, b, c, 황승배c, d, 곽효성c, d, 오선영a, b, c

a전북대학교 의과대학 신경과학교실

b전북대학교병원 신경과

c전북대학교병원 의생명연구원

d전북대학교 의과대학 영상의학과교실

Superior Altitudinal Visual Field Defect as Initial Manifestation of Posterior Reversible Encephalopathy Syndrome

Seung-Ho Jeon, MDa, b, c, Hyun-June Shin, MDa, b, c, Seung-Bae Hwang, MDc, d, Hyo-Sung Kwak, MDc, d, Sun-Young Oh, MDa, b, c

aDepartment of Neurology, Chonbuk National University Medical School, Jeonju, Korea

bDepartment of Neurology, Chonbuk National University Hospital, Jeonju, Korea

cBiomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea

dDepartment of Radiology, Chonbuk National University Medical School, Jeonju, Korea

Address for correspondence: Sun-Young Oh, MD Department of Neurology, Chonbuk National University Hospital, 20 Geonji-ro, Deokjin-Gu, Jeonju 54907, Korea Tel: +82-63-250-1896 Fax: +82-63-251-9363 E-mail: ohsun@jbnu.ac.kr

Received February 22, 2018       Revised June 27, 2018       Accepted June 27, 2018

Copyright © 2018 Korean Neurological Association

기저질환 없이 군복무 중인 21세 남자가 2주 전부터 발생한 상방수평시야결손을 주소로 내원하였다. 내원시 혈압이 180/110 mmHg이었으며, 안과검진에서 이상은 없었으나 대면검사와 험프리자동시야 검사상 양안의 상방수평시야결손이 관찰되었다(Fig. A). 뇌 자기공명영상검사에서 양측 내측 후두부에 아급성기 뇌경색이 확인되었으며(Fig. B-D), 뇌혈관조영술에서 양측 후대뇌동맥의 2번째 분지에서 혈관연축이 관찰되었다(Fig. E).
가역적후뇌병증은 조기에 유발요인 교정으로 완전히 회복되나 신경계이상을 남기는 경우도 종종 보고된다[1]. 양안의 상방수평시야결손은 드물게 보고되는 증상으로 주로 시신경교차 이전의 시신경 압박병터에서 발생하지만, 최근에 양측 조거동맥(calcarine artery) 아래 분지의 뇌경색에 의한 보고도 있다[2]. 본 증례에서 발견된 양측 시각피질병변은 후대뇌동맥과 하조거동맥(inferior calcarine artery)의 혈관연축의 결과 발생한 것으로 생각되는데, 그 원인은 조절되지 않은 고혈압으로 인한 것으로 추측된다.

REFERENCES

1. Burnett MM, Hess CP, Roberts JP, Bass NM, Douglas VC, Josephson SA. Presentation of reversible posterior leukoencephalopathy syndrome in patients on calcineurin inhibitors. Clinl Neurol Neurosurg 2010;112:886-891.
crossref
2. Luu ST, Lee AW, Chen CS. Bilateral occipital lobe infarction with altitudinal field loss following radiofrequency cardiac catheter ablation. BMC Cardiovasc Disord 2010;10:14.
crossref

Figure.
(A) Automated perimetry using Humphrey program of the right and left eye showed bilateral superior altitudinal field defects. Brain magnetic resonance imaging scan axial view, (B) diffusion weighted image, (C) apparent diffusion coefficient image at corresponding level, and (D) T1 enhanced sequence, showing area of abnormal signal in both occipital lobes and extending into the lower bank of calcarine sulcus (white arrows), consistent with subacute cerebral infarction. (E) In cerebral angiography, focal filling defect (white arrows) suggesting vasospasm in both posterior cerebral artery was identified.
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