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오일중,오준호,전보영 대한안과학회 2024 대한안과학회지 Vol.65 No.4
목적: 핵간마비는 일반적으로 뇌간 부위 안쪽세로다발의 손상으로 발생한다고 알려져 있다. 소아의 핵간마비는 대부분 두 눈에서 발생하며 주로 다발성 경화증에 의해 유발되나 저자들은 소아에서 외상에 의해 발생한 한 눈 핵간마비 1예를 경험하였기에 이를 보고하고자 한다. 증례요약: 14세 여아가 내원 9일 전 축구공에 오른눈을 세게 부딪혔으며 내원 5일 전부터 발생한 복시, 어지러움 및 구토 증상으로본원에 내원하였다. 왼쪽 주시 시 정중선을 넘지 못하는 오른눈 내전장애 및 왼눈 수평 안진이 관찰되었다. 내원 직후 시행한 전산화단층촬영상 오른눈 안와골절, 외안근 감돈 또는 손상은 없었으며 뇌 자기공명영상검사상 우측 중뇌 경색을 시사하는 소견이 관찰되었다. 환아는 오른눈 핵간마비로 진단되었으며 외상 7주 후 오른눈 내전장애, 왼눈 외전시 수평 안진 및 복시는 완전히 소실되었다. 결론: 소아에서 발생하는 핵간마비의 원인은 성인과 달리 다발성 경화증 등 탈수초성 질환에 의한 경우가 대부분이며 대부분 두 눈에발생한다. 소아에서 발생한 한 눈 핵간마비의 증례는 드물기에 이를 보고하고자 한다. Purpose: Internuclear ophthalmoplegia (INO) is an eye movement disorder caused by a lesion of the medial longitudinal fasciculus. It typically manifests bilaterally and is commonly caused by multiple sclerosis. We report a case of pediatric unilateral INO, which is rare in the pediatric population. Case summary: A 14-year-old female, with a history of traumatic head injury 9 days previously, presented with diplopia, nausea and vomiting for the past 5 days. Her ophthalmic examination revealed severely impaired adduction of the right eye and abduction nystagmus in the left eye. Orbital computed tomography showed no evidence of orbital wall fracture or muscle impingement. However, an magnetic resonance imaging of her brain demonstrated an infarct in the right paramedian midbrain, leading to a diagnosis of unilateral INO. Diplopia and impaired adduction of the right eye resolved completely 7 weeks after the trauma. Conclusions: Demyelinating diseases, such as multiple sclerosis, account for most of the pediatric INO cases. Although most of these cases are bilateral, this reports highlights a pediatric case of unilateral INO following head injury, which is an uncommon occurrence in this age group.
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Medial Longitudinal Fasciculus on MRI in a Patient with Internuclear Ophthalmoparesis: A Case Report
김성민,김호균,이희중 대한자기공명의과학회 2014 Investigative Magnetic Resonance Imaging Vol.18 No.2
The medial longitudinal fasciculus (MLF) is myelinated composite tract, lying near the midline, ventral to periaqueductalgrey matter that plays a key role in coordinating eye movements. A lesion of the MLF results in an ipsilateral adductiondeficit and a contralateral abducting nystagmus, referred to as an internuclear ophthalmoparesis. The blended tract withadjacent white matter in pons and midbrain is indistinguishable on brain imaging such as CT and MRI. Until now, to thebest of our knowledge, MLF is not delineated on in vivo MRI. We present a case showing the whole connecting courses ofMLF lesion on MRI in a patient with inflammatory demyelinating disorder.
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엄예진,홍철희,Eom, Ye-Jin,Hong, Chul-Hee 대한한방안이비인후피부과학회 2016 한방안이비인후피부과학회지 Vol.29 No.3
양안성 핵간안근마비의 전형적인 임상적 특징을 보이면서 뇌 자기공명영상검사(Brain Brain magnetic resonance imaging, Brain MRI)상 뇌간병변을 확인할 수 없었던 환자에 대하여 침치료, 약침치료, 전침치료, 한약치료 등의 한방치료를 통해 증상의 호전을 경험하였기에 이를 보고하는 바이다. Objectives : The aim of this study is to report the effect of Korean medicine treatment on bilateral internuclear ophthalmoplegia without abnormal findings on brain magnetic resonance imaging.Methods : The patient was treated by using acupuncture, electroacupuncture treatment and hominis placenta pharmacoacupuncture. The change of eye movement and strabismus were evaluated by comparison the photographs of the extraocular movements of patient. Strabismus also was evaluated by corneal reflex test.Results : Adduction of both eyes were improved after Korean medicine treatment. The amplitude and frequency of nystagmus showed a tendency to decrease in both eyes.Conclusions : Korean medicine treatment should be effective for the idiopathic bilateral internuclear ophthalmoplegia.
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중추성 및 말초성 안구운동장애 사례에 대한 고찰 - 한방치료를 시행한 3례를 중심으로
박준영,김영석,조기호,문상관,정우상,Park, Joon-Young,Kim, Young-Seok,Cho, Ki-Ho,Mun, Sang-Kwan,Jung, Woo-Sang 대한한방내과학회 2012 大韓韓方內科學會誌 Vol.33 No.4
Objectives : To report three cases of eye movement impairment: internuclear ophthalmoplegia (INO) due to pontine infarction, traumatic abducens nerve palsy, and abducens nerve involvement in Miller-Fisher syndrome. Cases Summary : There were three cases. First, a 64-year-old woman, who was given a diagnosis of INO due to pontine infarction, had left gaze palsy of her right eye while the convergence was intact. Second, a 34-year-old man had abduction impairment of his right eye after a traffic accident. Third, a 66-year-old man, who was diagnosed with Miller-Fisher syndrome, had left gaze palsy of his left eye. Their symptoms improved substantially and their anxieties were relieved after treatment with herbal medicine and acupuncture. Conclusions : There has been no certain cure for eye movement impairment yet. In this report, we present three successful cases of patients with eye movement impairment and show that Korean medical treatment could be a solution for this incurable disease.
KCI
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