後天性両側性上斜筋麻痺について

Acquired bilateral superior oblique palsy

　後天性両側性上斜筋麻痺6例の臨床所見についてまとめた．

　全例が成人男性であり，4例が交通事故による頭部外傷，1例が炎症に起因すると考えられた．1例は脳外科手術後に発症している．患者は特に下方視において強い複視を訴えるが外見上の眼位ずれ，眼球運動制限は小さい．本症は回旋を伴う交代性上下斜視およびV型内斜視において特徴があり，この2点が診断上有用であった．Bielschow-sky頭部傾斜試験で肉眼的に明らかな陽性を示す例はなく，頭部傾斜による上下の眼位ずれも比較的小さいものと考えられた．

We present six cases of acquired bilateral supe-rior oblique palsy. As etiological factors, postinfec-tious neuropathy was present in one case, previous surgery for recurrent frontal lobe tumor in another, and severe head trauma in traffic accident in the other four cases.

All the patients complained of torsional and vertical diplopia, which became worse in down gaze. The image seen by the right eye was underthat by the left eye in right-down gaze, and vice versa in left-down gaze. As a unique finding, the apparent deviation and the restriction of ocular movement were small. This feature seemed to occasionally cause a delay in diagnosis and initia-tion of appropriate therapy. V-pattern and excy-clotropia were further additional clinical manifes-tations of acquired bilateral superior oblique palsy and were considered to be of diagnostic value.

Rinsho Ganka (Jpn J Clin Ophthalmol) 42(1) : 65-68, 1988