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要約 目的:交通事故による頭頸部打撲後に視力と視野障害が生じ,脳脊髄液減少症と診断された症例の報告。
症例:28歳男性が自家用車を運転中に樹木に衝突し,右頭頸部を打撲した。翌日に視力低下を自覚した。矯正視力は右0.4,左1.2で,エアバッグによる角膜混濁と診断された。1か月後に視力が悪化して当科を受診した。
所見と経過:視力は右手動弁,左0.07で,両眼に求心性の視野狭窄と左眼に中心暗点があった。眼底に異常はなく,MRIでは脳と眼窩に異常はなかった。以後7か月間に視力と視野に変化はなかったが,補液により起立性頭痛と視機能が著明に改善した。脳脊髄圧は正常で,脳槽シンチグラフィで髄液漏出像はなく,RIクリアランスが亢進していた。外傷後の脳脊髄液減少症と診断した。硬膜外自家血注入で,視力は右0.8,左1.0に改善し,視野障害も回復した。
結論:頭頸部への鈍性外傷後に生じた視力障害と視野狭窄は,脳脊髄液減少症によると推定され,硬膜外自家血注入が有効であった。
Abstract Purpose:To report a case who developed visual field constriction presumably due to cerebrospinal fluid(CSF)hypovolemia following traffic accident.
Case:A 28-year-old male suffered blunt trauma to the head and neck after hitting a tree while driving. Corrected visual acuity was 0.4 right and 1.2 the following day. He visited us after impairment of vision one month later.
Findings and Clinical Course:Corrected visual acuity was hand motion right and 0.07 left. Both eyes showed constricted visual field. The left eye showed central scotoma. The fundus in both eyes appeared normal. Magnetic resonance imaging(MRI)showed normal findings in the brain and orbits. Vision and visual field remained unchanged during the ensuing 7 months. CSF hypovolemia was suspected after the visual function improved following intravenous infusion of electrolytes. Lumbar puncture showed normal CSF pressure. Radioisotope cisternography showed no CSF leakage but accelerated radioisotope clearance. He was diagnosed with CSF hypovolemia. Epidural patch was followed by improved visual acuity, visual field, and other systemic manifestations.
Conclusion:Constriction of visual field and impaired visual acuity appeared to be secondary to CSF hypovolemia. Epidural blood patch was effective for visual manifestations.
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