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Rinsho Ganka Volume 75, Issue 4 （April 2021）

臨床眼科 75巻4号（2021年4月発行）

Japanese English

臨床報告

病状評価に光干渉断層計が有用であった特発性頭蓋内圧亢進症の1例 A case of idiopathic intracranial hypertension in which optical coherence tomography was useful for evaluation 畑中彬良 ¹ , 木下貴正 ¹ , 今泉寛子 ¹ Akira Hatanaka ¹ , Takamasa Kinoshita ¹ , Hiroko Imaizumi ¹ ¹市立札幌病院眼科 ¹Department of Ophthalmology, Sapporo City General Hospital pp.469-477

発行日 2021年4月15日 Published Date 2021/4/15

DOI https://doi.org/10.11477/mf.1410213958

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要約　目的：病状評価に光干渉断層計（OCT）が有用であった特発性頭蓋内圧亢進症の1例の報告。

症例：42歳，女性。3か月前より起立時に両眼が数秒間暗くなる症状が続いたため，市立札幌病院眼科を初診した。両眼に視神経乳頭の著明な腫脹，網膜静脈の拡張および蛇行を認め，右眼の視神経乳頭耳側縁に網膜皺襞（Paton's line）を伴っていた。OCTでは両眼の視神経乳頭の腫脹に加え，乳頭鼻側縁に漿液性網膜剝離，右眼視神経乳頭耳側縁に網膜皺襞を認めた。視神経乳頭周囲の網膜は内層だけでなく外層も肥厚していた。両眼の乳頭周囲の強膜，脈絡膜，網膜色素上皮は前方へ突出，変形していた。各種検査から特発性頭蓋内圧亢進症と診断した。腰椎穿刺およびアセタゾラミドの内服後，視神経乳頭の腫脹は軽減し，再発なく経過している。

結論：本症例では視神経乳頭周囲の網膜は内層だけでなく外層も肥厚し，治療としては短期的には腰椎穿刺が，長期的にはアセタゾラミド内服が有効であった。特発性頭蓋内圧亢進症においてOCTは乳頭腫脹のみならず，治療前後の層別の網膜厚変化を非侵襲的に定量化することができ，病状評価に有用であると思われた。

Abstract　Purpose：To report of a case of idiopathic intracranial hypertension in which optical coherence tomography（OCT）was useful for evaluating the changes in optic disc edema and retinal swelling before and after treatment.

Case and Findings：A 42-year-old female presented with a 3-month history of mild transient amourosis that persisted for several seconds when she stood up. Dilated fundus examination showed marked optic disc swelling, and dilation and meandering of the retinal vein in both eyes. Circumferential retinal folds around the optic disc were also observed in the right eye. OCT showed swelling of the optic disc and serous retinal detachment at the nasal margin of the optic disc in both eyes, and superficial retinal folds on the temporal margin of the right optic disc. Not only the inner retina, but also the outer retina was thickened. The sclera, choroid, and retinal pigment epithelium around the optic disc protruded forward in both eyes. Examinations led to the diagnosis of idiopathic intracranial hypertension. After lumbar puncture and oral administration of acetazolamide, swelling of the optic disc decreased in both eyes, which was confirmed by OCT. Since then, the patient has been asymptomatic.

Conclusions：In this case, OCT delineated not only inner retinal but also outer retinal thickening around the optic disc. Lumbar puncture and oral dose of acetazolamide were effective for the treatment of idiopathic intracranial hypertension. In cases with idiopathic intracranial hypertension, OCT can noninvasively quantify not only the optic disc swelling but also the layer-by-layer change in retinal thickness before and after treatment.