スペクトラルドメイン光干渉断層計でうっ血乳頭を3次元的に評価できた特発性頭蓋内圧亢進症の1例

Three-dimensional evaluation of papilledema in a case of idiopathic intracranial hypertension using spectral domain optical coherence tomography

要約　目的：スペクトラルドメイン光干渉断層計（SD-OCT）でうっ血乳頭の経過を追った特発性頭蓋内圧亢進症の症例の報告。症例：46歳男性が1か月前からの両眼の変視症で受診した。所見：視力は右1.2，左1.0で，視神経乳頭腫脹が両眼にあった。MRIで頭蓋内に占拠性病変はなかった。脳脊髄圧が300mmH₂Oと亢進し，特発性頭蓋内圧亢進症と診断した。SD-OCTによる乳頭の容積は，右5.03mm³，左5.12mm³で，アセタゾラミド内服を行った。5か月後の乳頭容積は，右3.25mm³，左3.39mm³であった。結論：SD-OCTによる乳頭の3次元的検査で，特発性頭蓋内圧亢進症の治療効果を非侵襲的かつ客観的に評価できた。

Abstract.　Purpose：To report a case of idiopathic intracranial hypertension with papilledema followed up using a spectral domain optical coherence tomography（SD-OCT）. Case：A 46-year-old male presented with metamorphopsia in both eyes since one month before. Findings：Visual acuity was 1.2 right and 1.0 left. Magnetic resonance imaging（MRI）showed no space-occupying lesion in the skull. Both eyes showed papilledema. Cerebrospinal fluid pressure was elevated to 300 mmH₂O, leading to the diagnosis of idiopathic intracranial hypertension. Volume of optic disc was 5.03 mm³ right and 5.12 mm³ left when measured by SD-OCT. Five months after treatment with peroral acetazolamide, the disc volume decreased to 3.25 mm³ right and 3.39 mm³ left. Conclusion：Therapeutic outcome of idiopathic intracranial hypertension could be objectively evaluated by use of SD-OCT.