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要約 目的:眼部帯状疱疹の経過中に全眼球麻痺が発症した症例の報告。症例:62歳男性が3日前からの右側帯状疱疹として紹介された。右眼に角膜ぶどう膜炎があり,抗ウイルス薬,抗菌薬,ステロイドの局所投与で炎症は軽快した。発症から19日目に右側の眼窩周囲痛,眼瞼下垂,散瞳,全方向の眼球運動障害が生じた。磁気共鳴画像検査(MRI)で右海綿静脈洞部にガドリニウムによる増強効果があり,海綿静脈洞の病変による全眼筋麻痺と診断した。ステロイドと抗ウイルス薬の全身投与を行い,3か月後に眼球運動障害が消失し,4か月後のMRIで海綿静脈洞部の増強効果が消失した。結論:本症例では三叉神経の炎症が海綿静脈洞部で動眼神経と外転神経に波及した可能性がある。診断と治療効果の判定にMRIが有用であった。
Abstract. Purpose:To report a case of herpes zoster ophthalmicus followed by total ophthalmoplegia. Case:A 62-year-old male was referred to us for herpes zoster ophthalmicus since 3 days before. His right eye showed keratouveitis that improved after topical treatment with corticosteroid and antiviral drugs. Nineteen days after onset, he developed right-sided periorbital pain, eyelid ptosis and restricted ocular motility in all directions. Magnetic resonance imaging(MRI)showed gadolinium enhancement in the right cavernous sinus area. He was diagnosed with total ophthalmoplegia secondary to lesion in the cavernous sinus. Systemic treatment with corticosteroid and antiviral agent was followed by improved ocular motility 3 months later. MRI another month later showed no enhancement in the cavernous sinus area. Conclusion:Inflammation of trigeminal nerve may have spread to oculomotor and abducens nerves in the cavernous sinus area. MRI was useful in the diagnosis and follow-up in the present case.
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