임신성 고혈압에 의한 유두부종과 외향신경 마비를 동반한 환자 1예

Abstract

Purpose: Abducens nerve palsy complicating pre-eclampsia during pregnancy occurs very rarely. The authors describe right abducens nerve palsy, disc swelling, and hypertensive retinopathy found in both eyes of a pre-eclampsia patient. Case summary: A 29-year-old woman, who was in her 31st week of gestation, was admitted to the hospital complaining chiefly of diplopia and abduction limitation in her right eye, which started suddenly 3 weeks prior to admission. Her condition was carefully followed up by a local clinic because this symptom of hypertension manifested one month before her admission to the local clinic. Brain MRI and laboratory tests were performed in order to exclude diseases of the central nervous system and/or other systemic diseases. An alternative prism cover test showed approximately 25PD (prism diopter) right esotropia, with -2 degrees abduction limitation observed in the patient's right eye. Both hypertensive retinopathy and papilledema were observed. Her blood pressure was 155/110 mmHg, and she had moderate proteinuria when she was admitted to the hospital. She was referred to an obstetrician and diagnosed as having pre-eclampsia. Other than pre-eclampsia with proteinuria, the brain imaging examination failed to reveal any particular findings, such as CNS disorders, including brain edema, cerebral infarction, or a brain tumor. In addition, systemic diseases which might have caused papilledema and abducens nerve palsy, including diabetes mellitus, were not evident in this case. Therefore, the patient was diagnosed with ischemic abducens nerve palsy and hypertensive retinopathy complicating moderate pre-eclampsia. The patient’s diplopia and right eye abduction limitation were gradually relieved after parturition.

목적 : 자간전증의 발생과 함께 우안 외향신경 마비와 양안 유두부종과 고혈압성 망막병증을 동반한 환자를 경험하여보고하고자 한다. 증례요약 : 임신 31주의 29세 여자환자가 3주전 발생한 복시와 우안의 안구운동장애를 주소로 내원하였다. 환자는 내원 1개월 전부터 발생한 고혈압으로 경과관찰 중이었으며 중추신경계 및 다른 전신질환을 감별하기 위해 뇌 자기공명영상, 혈당, 항핵항체 검사 등을 시행하였다. 25PD (prism diopter)의 우안 내사시와 -2 정도의 우안 외전장애를보였으며, 양안의 유두부종을 동반한 고혈압성 망막병증 소견을 보였다. 내원시 155/110 mmHg의 고혈압, 중등도의단백뇨 소견으로 산부인과에서 자간전증으로 진단받았다. 단백뇨를 동반한 자간전증 외에는 유두부종 및 외향신경 마비를 유발할 만한 뇌종양등 중추신경계 이상 및 당뇨 등 전신질환 발견되지 않아 중증 자간전증에 동반된 허혈성 외향신경 마비 및 고혈압성 망막병증으로 진단하였다. 환자는 출산 후 고혈압 및 단백뇨 소실과 함께 복시 및 우안의 외전 제한 증상은 소실되었고 시신경 유두 부종 역시 감소되었다.