Red-eyed shunt syndromeの逆説的悪化と考えられた1例

Paradoxical exacerbation in a case of red-eyed shunt syndrome

要約　目的：Red-eyed shunt syndromeが逆説的に悪化した症例の報告。症例と経過：85歳女性が両眼の視力低下で受診した。矯正視力は右0.6，左0.4で，上強膜血管の拡張と蛇行，切迫型網膜中心静脈閉塞症が両眼にあった。眼球突出，頸部血管雑音，神経学的異常はなかった。頭部のCTで上眼静脈の拡張が両眼にあったが，内頸動脈海綿静脈洞瘻（CCF）はなく，6日後の脳血管造影と頭部磁気共鳴画像検査（MRI）で異常所見はなかった。初診から4か月後に，両眼上強膜の血管拡張と蛇行，両眼の切迫型網膜中心静脈閉塞症は自然寛解した。結論：両眼の上強膜血管の拡張と眼底出血から本症がred-eyed shunt syndromeと診断した。脳血管造影でCCFがなかったことは，本症例の経過が本症候群の逆説的悪化として解釈できる。

Abstract.　Purpose：To report a case with paradoxical exacerbation of red-eyed shunt syndrome. Cases and Method：An 85-year-old female presented with impaired visual acuity in both eyes. Corrected visual acuity was 0.6 right and 0.4 left. Both eyes showed dilatation and tortuosity of episcleral vessels and impending central retinal vein occlusion（CRVO）. She showed no proptosis,vascular murmur in neck area,or neurological disorders. Computed tomography（CT）showed bilateral dilatation of superior ophthalmic vein and no carotid-cavernous sinus fistula（CCF）. No abnormality was detected by cerebral angiography and magnetic resonance imaging 6 days later. Bilateral ocular lesions resolved spontaneously 4 months after her initial visit. Conclusion：This case was diagnosed with red-eyed shunt syndrome by the presence of dilated episcleral vessels and impending CRVO in both eyes. Absence of CCF can be explained as paradoxical exacerbation of this syndrome.