糖尿病があり，片側外転神経麻痺で発症したくも膜下出血の1例

Abducens palsy as the initial manifestation of subarachnoid hemorrhage in a diabetic patient

要約　目的：外転神経麻痺を初発症状としたくも膜下出血の1例の報告。症例：56歳男性が前日からの複視で受診した。糖尿病があり，慢性腎不全で透析中であった。開放隅角緑内障で加療していた。所見：矯正視力は右0.4，左1.0で，左眼に外転制限があった。MRIで左橋の外側に占拠性病変があり，くも膜下出血が疑われた。病変は自然寛解し，6か月後に複視は消失した。結論：頭痛や意識障害を伴わず，外転神経麻痺を初発症状としてくも膜下出血が発症することがある。

Abstract.　Purpose：To report a case of subarachnoid hemorrhage with abducens palsy as the initial manifestation. Case：A 56-year-old male presented with diplopia since one day before. He had had diabetes mellitus and been receiving hemodialysis for chronic renal failure. He had been treated for chronic open-angle glaucoma. Findings：Corrected visual acuity was 0.4 right and 1.0 left. The left eye showed limited abduction. MRI showed a space-occupying lesion lateral to the left pons. The findings led to the diagnosis of suspected subarachnoid hemorrhage. The lesion was absorbed after conservative treatment. Diplopia disappeared 6 months later. Conclusion：This case illustrates that subarachnoid hemorrhage may fail to show headache or impaired consciousness with abducens palsy as the initial manifestation.