頭部外傷後に急性の経過で両側失明し，可逆性脳血管攣縮症候群が疑われた1例
症例は62歳男性．頭部外傷2日後の急性両側失明のために当科に入院した．頭部MRIでは小脳の出血性梗塞を認め，頭部MRAでは末梢動脈の描出不良を認めた．急性発症の失明で視神経炎を鑑別に挙げ診断的治療としてステロイド治療を施行したが視力に改善はみられなかった．9日後のMRA再検では，動脈の描出に改善を認め，可逆性脳血管攣縮症候群（reversible cerebral vasoconstriction syndrome，以下RCVSと略記）が示唆された．当初，眼底検査では視神経乳頭の異常は認められなかったが約1か月後から視神経萎縮が出現し，後部虚血性視神経症の可能性が示唆され，RCVSが誘因と考え...
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| Published in | 臨床神経学 Vol. 63; no. 12; pp. 824 - 829 |
|---|---|
| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本神経学会
2023
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0009-918X 1882-0654 |
| DOI | 10.5692/clinicalneurol.cn-001889 |
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| Abstract | 症例は62歳男性．頭部外傷2日後の急性両側失明のために当科に入院した．頭部MRIでは小脳の出血性梗塞を認め，頭部MRAでは末梢動脈の描出不良を認めた．急性発症の失明で視神経炎を鑑別に挙げ診断的治療としてステロイド治療を施行したが視力に改善はみられなかった．9日後のMRA再検では，動脈の描出に改善を認め，可逆性脳血管攣縮症候群（reversible cerebral vasoconstriction syndrome，以下RCVSと略記）が示唆された．当初，眼底検査では視神経乳頭の異常は認められなかったが約1か月後から視神経萎縮が出現し，後部虚血性視神経症の可能性が示唆され，RCVSが誘因と考えられた． |
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| AbstractList | 症例は62歳男性．頭部外傷2日後の急性両側失明のために当科に入院した．頭部MRIでは小脳の出血性梗塞を認め，頭部MRAでは末梢動脈の描出不良を認めた．急性発症の失明で視神経炎を鑑別に挙げ診断的治療としてステロイド治療を施行したが視力に改善はみられなかった．9日後のMRA再検では，動脈の描出に改善を認め，可逆性脳血管攣縮症候群（reversible cerebral vasoconstriction syndrome，以下RCVSと略記）が示唆された．当初，眼底検査では視神経乳頭の異常は認められなかったが約1か月後から視神経萎縮が出現し，後部虚血性視神経症の可能性が示唆され，RCVSが誘因と考えられた． |
| Author | 大場, 洋 小林, 俊輔 高橋, 和沙 千葉, 隆司 北國, 圭一 園生, 雅弘 三村, 達哉 藤井, 勇基 |
| Author_xml | – sequence: 1 fullname: 大場, 洋 organization: 帝京大学医学部附属病院放射線科 – sequence: 1 fullname: 園生, 雅弘 organization: 帝京大学医療技術学部視能矯正学科 – sequence: 1 fullname: 小林, 俊輔 organization: 帝京大学医学部附属病院脳神経内科 – sequence: 1 fullname: 高橋, 和沙 organization: 北里大学脳神経内科 – sequence: 1 fullname: 藤井, 勇基 organization: 帝京大学医学部附属病院脳神経内科 – sequence: 1 fullname: 千葉, 隆司 organization: 帝京大学医学部附属病院脳神経内科 – sequence: 1 fullname: 北國, 圭一 organization: 帝京大学医学部附属病院脳神経内科 – sequence: 1 fullname: 三村, 達哉 organization: 帝京大学医学部附属病院眼科 |
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| References | 2) Ducros A. Reversible cerebral vasoconstriction syndrome. Lancet Neurol 2012;11:906-917. 5) Hayreh SS. Posterior ischaemic optic neuropathy: clinical features, pathogenesis, and management. Eye 2004;18:1188-1206. 4) Lee AG, Brazis PW, Miller NR. Posterior ischemic optic neuropathy associated with migraine. Headache J Head Face Pain 1996;36:506-510. 9) Foroozan R, Marx DP, Evans RW. Posterior ischemic optic neuropathy associated with migraine. Headache 2008;48:1135-1139. 8) Yonezawa Y, Koga K, Higashi Y, et al. A successfully treated case of posterior ischemic optic neuropathy that developed during antihypertensive therapy for hypertensive emergency. Intern Med Advance Publication, 2023; https://doi.org/10.2169/internalmedicine.1550-23. 1) Ducros A, Boukobza M, Porcher R, et al. The clinical and radiological spectrum of reversible cerebral vasoconstriction syndrome. A prospective series of 67 patients. Brain 2007;130:3091-3101. 6) Biousse V, Newman NJ. Ischemic optic neuropathies. N Engl J Med 2015;372:2428-2436. 10) Dăscălescu D, Corbu C, Șram L, et al. The pathophysiology of Sumatriptan induced non-arteritic anterior ischemic optic neuropathy. Rom J Ophthalmol 2022;66:352-355. 3) Hickman SJ, Dalton CM, Miller DH, et al. Management of acute optic neuritis. Lancet 2002;360:1953-1962. 7) Sadda SR, Nee M, Miller NR, et al. Clinical spectrum of posterior ischemic optic neuropathy. Am J Ophthalmol 2001;132:743-750. |
| References_xml | – reference: 3) Hickman SJ, Dalton CM, Miller DH, et al. Management of acute optic neuritis. Lancet 2002;360:1953-1962. – reference: 8) Yonezawa Y, Koga K, Higashi Y, et al. A successfully treated case of posterior ischemic optic neuropathy that developed during antihypertensive therapy for hypertensive emergency. Intern Med Advance Publication, 2023; https://doi.org/10.2169/internalmedicine.1550-23. – reference: 2) Ducros A. Reversible cerebral vasoconstriction syndrome. Lancet Neurol 2012;11:906-917. – reference: 7) Sadda SR, Nee M, Miller NR, et al. Clinical spectrum of posterior ischemic optic neuropathy. Am J Ophthalmol 2001;132:743-750. – reference: 9) Foroozan R, Marx DP, Evans RW. Posterior ischemic optic neuropathy associated with migraine. Headache 2008;48:1135-1139. – reference: 1) Ducros A, Boukobza M, Porcher R, et al. The clinical and radiological spectrum of reversible cerebral vasoconstriction syndrome. A prospective series of 67 patients. Brain 2007;130:3091-3101. – reference: 6) Biousse V, Newman NJ. Ischemic optic neuropathies. N Engl J Med 2015;372:2428-2436. – reference: 10) Dăscălescu D, Corbu C, Șram L, et al. The pathophysiology of Sumatriptan induced non-arteritic anterior ischemic optic neuropathy. Rom J Ophthalmol 2022;66:352-355. – reference: 4) Lee AG, Brazis PW, Miller NR. Posterior ischemic optic neuropathy associated with migraine. Headache J Head Face Pain 1996;36:506-510. – reference: 5) Hayreh SS. Posterior ischaemic optic neuropathy: clinical features, pathogenesis, and management. Eye 2004;18:1188-1206. |
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| SubjectTerms | 可逆性脳血管攣縮症候群 急性両側視力障害 虚血性視神経症 |
| Title | 頭部外傷後に急性の経過で両側失明し，可逆性脳血管攣縮症候群が疑われた1例 |
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