分娩後の一過性皮質盲

Postpartum cortical blindness

　24歳初産婦の患者は分娩直後に突然の両眼視力障害を生じ，視力は光覚弁となった。眼底と対光反応に異常はなく，CT, MRIにて両側後頭葉に浮腫と考えられる異常像を認めた。治療により，急速かつ完全に回復した。過去の同様な報告24例をあわせて検討した。妊娠に関連した皮質盲の発症時期は，妊娠末期から分娩直後にかけて多く，若年層か高年層の，初産婦に多い傾向があった。子癇と妊娠中毒症が危険因子であり，視力低下は両眼性で，光覚弁以下が大部分であった。回復は急速で後遺症をほとんど残さなかった。

A 24-year-old woman went through uneventful first pregnancy and childbirth. The following day, she developed severe headache, nausea and sudden loss of bilateral vision. She manifested normal fundus and pupillary reflexes in both eyes. Immedi-ate CT scan and MRI imaging showed edematous changes in the bilateral occipital lobes and basalganglia. Treatment with intravenous corticosteroid and hyperosmotic glycerol led to complete recovery of vision and resolution of cerebral edema 4 days later. We could locate 24 case reports of cortical blindness during or after pregnancy. Cerebral edema secondary to cerebral arterial vasospasm has been suspected as the underlying cause of visual loss.