視力障害を初発とし，初診から2週間の経過で死亡した髄膜癌腫症の1例

A case of meningeal carcinomatosa with visual impairment as the initial manifestation two weeks prior to death

要約　目的：視力障害で初発し，2週間後に死亡した髄膜癌腫症の1症例の報告。

症例：61歳の男性が3日前からの右眼視力低下で受診した。矯正視力は右手動弁，左0.4であった。右眼に相対的瞳孔求心路障害と耳側周辺のみを残す視野欠損があった。眼底には異常所見がなく，造影MRI検査で頭蓋内に異常所見がなかった。その翌日に両眼の視野障害が進行し，髄液に異型細胞が検出され，CTで肺腫瘤が発見された。以上から肺癌に続発した髄膜癌腫症が疑われたが，初診から16日後に死亡した。

結論：本症例での急速に進行した視力と視野障害は，肺癌に続発した髄膜癌腫症がその原因であったと推定される。

Abstract　Purpose：To report a case of presumed meningeal carcinoma metastatic from pulmonary adenocarcinoma with rapid-onset visual impairment as the initial manifestation.

Case：A 61-year-old male presented with impaired vision in the right eye since 3 days before. His best corrected visual acuity was hand motion in the right eye and 0.4 in the left. The right eye showed impaired relative afferent pupillary defect and visual field constriction leaving the temporal sector only. The fundus findings were normal. No cerebral lesion was detected by contrast-enhanced magnetic resonance imaging. Visual field defects developed in both eyes the following day. Cerebrospinal fluid showed atypical cells. Computed tomography showed a tumor mass in the lung. He was tentatively diagnosed with meningeal carcinoma metastatic from pulmonary adenocarcinoma. His general condition deteriorates rapidly until his decease 16 days after his initial visit.

Conclusion：Rapidly progressive visual impairment in the present case appears to have been secondary to meningeal carcinoma metastatic from pulmonary adenocarcinoma.