外側膝状体半盲を呈した脳内Wegener肉芽腫の1例

A case of Wegener's granuloma of the central nervous system with geniculate hemianopia

　2か月前に外耳道炎が発症し，続いて半月体性糸球体腎炎が起こり，血中の抗好中球細胞質抗体値が上昇してWegener肉芽腫症と診断された43歳女性が視野障害を主訴として受診した。両眼に右側楔型の同名半盲があり，MRI検査で左側の外側膝状体外側音部に境界明瞭な円形の腫瘍が発見された。ステロイドのパルス療法で脳内病変は著しく縮小した。本症での外側膝状体半盲の原因病変は，脳内に生じた孤発性のWegener肉芽腫と推定された。

A 43-year-old female presented with visual disturbance of recent onset. She had external otitis two months before followed by semilunar glomerulonephritis with elevated serum level of antineutrophil anti-bodies. These findings led to the diagnosis of Wegener's granulomatosis. Both eyes showed wedge-shaped right homonymous hemianopia. Magnetic resonance imaging showed round and sharply demarcated tumor lateral to the left lateral geniculate body. The intracerebral lesion remarkably decreased in size after pulse therapy with systemic corticosteroid. The observed intracerebral lesion responsible for the homonymous hemianopia appeared to be solitary Wegener's granuloma.