急性扁桃炎に続発した海綿静脈洞炎によるTolosa-Hunt様症候群の1例

A case simulating Tolosa-Hunt syndrome secondary to cavernous sinusitis and acute tonsillitis

　急性扁桃炎から化膿性髄膜炎，敗血症が起こり，その加療中非拍動性の眼痛が5日間持続したのち，眼瞼下垂，全眼球運動障害，反対側眼球の外転障害を認めた1例を経験した。CT,MRI検査で蝶形骨洞と海綿静脈洞との骨壁が欠損しており，同部に肉芽腫性変化を認め，Tolosa-Hunt様症候群を呈したものと考えた。CT,MRIの両検査で海綿静脈洞の肉芽腫性変化を捉え得た症例は少なく，ここに報告する。副鼻腔炎の約3％が蝶形骨洞炎との報告があり，自験例のような後部眼窩蜂窩織炎は決して多くはないが，眼球運動障害や複視を認めれば，後部篩骨洞や蝶形骨洞の炎症をも念頭におかなければならないと思われた。

A 52-year-old man presented with suppurative meningitis and sepsis following acute tonsillitis. Severe left retroorbital pain had been present for 5 days. The left eye showed total ophthalmoplegia with ptosis. The right eye showed restricted motility in the outward direction. Both eyes were free of conjunctival congestion or fundus disorders.

Computed tomography and magnetic resonance imaging showed defects in the septum between thecavernous and sphenoidal sinus. The cavernous sinus showed granulomatous appearance. These lesions seemed to have induced paralyses of left cranial nerves Ⅲ, Ⅳ and Ⅵ and of right cranial nerve Ⅵ. The present case is thus regarded as Tolosa-Hunt-like syndrome. This case is unique because of an unusual involvement of posterior orbital cellulitis secondary to sphenoid sinusitis.