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조영증강을 보인 외상성 시신경병증

Traumatic Optic Neuropathy With Gadolinium Enhancement

대한안신경의학회지 2020년 10권 2호 p.44 ~ 46
오은혜, 최서영, 최광동, 최재환,
소속 상세정보
오은혜 ( Oh Eun-Hye ) - Pusan National University Yangsan Hospital Department of Neurology
최서영 ( Choi Seo-Young ) - Pusan National University Hospital Department of Neurology
최광동 ( Choi Kwang-Dong ) - Pusan National University Hospital Department of Neurology
최재환 ( Choi Jae-Hwan ) - Pusan National University Yangsan Hospital Department of Neurology

Abstract


Most patients with traumatic optic neuropathy show normal conventional magnetic resonance imaging (MRI) finding although abnormal diffusion restriction within the optic nerve can be seen in some patients. A 62-year-old man presented with visual loss of the right eye after blunt ocular injury. He could not recognize the light with his right eye. Neuro-ophthalmological examinations showed conjunctival injection and dilated fixed pupil with depression and adduction deficit of the right eye. MRI scans of the orbit revealed abnormal gadolinium enhancement along the right optic nerve sheath without diffusion restriction. With a diagnosis of traumatic optic and oculomotor neuropathy, we tried high dose steroid (methylprednisolone, 1 g/day) injection for five days. Although the ophthalmoplegia was fully recovered after four months, the visual loss persisted with optic atrophy. Abnormal enhancement of the optic nerve sheath in our patient may be ascribed to a trauma-induced local breakdown of the blood-nerve barrier with consequent inflammation and edema formation or microhemorrhage in the subarachnoid space surrounding the optic nerve.

키워드

Traumatic optic neuropathy; Optic nerve sheath; Gadolinium enhancement

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