副鼻腔真菌症に続発した海綿静脈洞血栓症と内頸動脈瘤による眼窩先端部症候群の1例

A case of orbital apex syndrome following cavernous sinus thrombosis and aneurysm of internal carotid artery secondary to paranasal fungal sinusitis

要約　目的：副鼻腔真菌症から海綿静脈洞血栓症と海綿静脈洞部の内頸動脈瘤が生じ，眼窩先端部症候群が発症した1例の報告。

症例と経過：糖尿病と膀胱癌の既往がある82歳女性に，2日間の発熱後，右眼瞼腫脹と外転神経麻痺が生じ，さらに2日後に右眼瞼下垂と眼球運動全障害が生じた。頭部のMRIで，右側の海綿静脈洞血栓症，右海綿静脈洞部の内頸動脈瘤と左上顎洞炎が発見された。眼科を紹介され，右眼窩先端部症候群と診断された。その後，左海綿静脈洞から上眼静脈に及ぶ血栓が生じ，内頸動脈瘤も急速に増大した。左上顎洞の副鼻腔炎への手術で，アスペルギルス感染が判明した。動脈瘤の治療として内頸動脈の結紮術が行われた。手術の合併症はなかったが，動眼神経麻痺は残った。

結論：副鼻腔感染を伴う眼窩先端部症候群では，感染性内頸動脈瘤や海綿静脈洞血栓症が原因になることがある。

Abstract　Purpose：To report a case of orbital apex syndrome following cavernous sinus thrombosis and aneurysm of internal carotid artery secondary to paranasal fungal sinusitis.

Case and Clinical Course：An 82-year-old female developed fever followed, 2 days later, by swelling of the right eyelid and abducens palsy. She had a history of diabetes mellitus and carcinoma of the bladder. She developed, anoter 2 days later, ptosis of the right eyelid and total ophthalmoplegia. Magnetic resonance imaging led to the diagnosis of thrombosis of the right cavernous sinus, aneurysm of internal carotid artery at the site of cavernous sinus, and maxillary sinusitis. She was diagnosed with right orbital apex syndrome. She developed thrombosis extending from the left cavernous sinus to superior ophthalmic vein. Surgery of left maxillary sinusitis led to the detection of infection by aspergillus. The internal carotid was ligated as treatment of the aneurysm. There was no complication of surgery except persistent oculomotor palsy.

Conclusion：The present case illustrates that orbital apex syndrome with infectious parasinusitis may be secondary to infectious aneurysm of internal carotid artery and cavernous sinus thrombosis.