ブラッドパッチ治療によって改善した交通外傷後の調節麻痺の1例

A case of post-traumatic regulatory paralysis that improved after blood patch treatment

要約　目的：交通外傷後に複視・調節麻痺を主訴に受診し脳脊髄液漏出症と診断され，ブラッドパッチ治療を実施し，症状が改善した症例を経験した。

症例：14歳の女児が自転車で走行中に乗用車と衝突し，ボンネットに跳ね上げられ受傷した。頭部CTで異常を認めず経過観察となっていたが，受傷約1週間後から立体感の異常，ぼやけ，複視，頭頸部痛，めまい，聴覚異常，頭痛を自覚し，精査加療のため当院を紹介され受診となった。

所見：初診時，両眼矯正視力は右1.2，左1.2であり，前眼部・中間透光体・眼底に明らかな異常は認められなかった。アコモドメーターで調節緊張と調節力の低下を認めた。両眼単一注視野検査では上方視での複視を認めた。眼窩下壁骨折はCT画像上認めなかったものの，上方複視症状からwhite-eyed blowout fractureが疑われ，受傷54日目に右眼窩下壁骨折整復術を施行し複視は改善した。その後，脳脊髄液漏出症が判明し，受傷142日目にブラッドパッチ治療を実施した。ブラッドパッチ治療から1か月後の再診時には調節麻痺が改善し，不定愁訴も改善していた。

結論：交通外傷による眼外傷や頭部外傷後に複視や調節麻痺，その他の不定愁訴を訴えるものの原因がはっきりしない場合，脳脊髄液漏出症の可能性も念頭に置き精査する必要がある。

Abstract　Purpose：A 14-year-old girl was diagnosed with cerebrospinal fluid（CSF）leakage after a car accident, and her symptoms improved after blood patch treatment.

Case：She was riding a bicycle when she collided with a passenger car and was bounced off the hood.

Approximately a week after the injury, she became aware of abnormal stereopsis, diplopia, paralysis, head and neck pain, dizziness, abnormal hearing and headache, and was referred to our clinic for further examination and treatment.

Findings：At the time of the initial examination, the corrected visual acuity of both eyes was 1.2, and there were no obvious abnormalities in the anterior segment, midperiphery, or fundus. Accommodometry revealed decreased regulatory tone and control；the findings of binocular single visual field test indicated diplopia in the upper visual field. Although no suborbital wall fracture was found on CT imaging, a white-eyed blowout fracture was suspected based on the symptoms of upward diplopia. Repair of a right suborbital wall fracture was performed on day 54 of injury, and the diplopia improved. Subsequently, CSF was noted, and blood patch treatment was performed on day 142 of injury. At the one-month follow up after the blood patch treatment, the patient's paralysis and other symptoms had improved.

Conclusion：When a patient complains of diplopia, paralysis, and other symptoms after ocular trauma or head injury caused by a road traffic accident, careful examination must be performed considering the possibility of CSF leakage.