軽微な頭部外傷で発症した動眼神経単独障害の1例

Isolated Traumatic Oculomotor Nerve Palsy Caused by Minor Head Trauma

はじめに

　頭部外傷患者で動眼神経単独障害を呈する症例は比較的稀であり，また報告例の多くは，意識障害があり，頭蓋底骨折や外傷性くも膜下出血などの頭蓋内合併損傷を併発していることが多い。今回われわれは，軽微な頭部外傷を契機に意識障害や頭蓋内合併損傷を認めず，片側性動眼神経単独障害を呈した稀な症例を経験したので報告する。

Abstract

　Isolated traumatic oculomotor nerve palsy caused by minor head trauma is extremely rare.　We report a case of this condition.　A 65-year-old woman was transferred to our hospital after minor head injury.　Initial examination of her right eye revealed a dilated pupil.　The result of computed tomography, magnetic resonance imaging, and magnetic resonance angiography of the brain were normal.　An examination conducted 6 hours after the accident, examination demonstrated right ptosis, and another conducted 20 hours after the accident, she demonstrated partial limitation of adduction, supraduction, and infraduction of the right eye.　Constructive interference in steady-state magnetic resonance imaging demonstrated a slightly rough-shaped oculomotor nerve near the posterior petroclinoid ligament.　After 8 months of the accident, the ptosis and limited eye movement were resolved.　However, the right dilation of the right pupil persisted.　Our case suggests that even minor head trauma can cause isolated oculomotor palsy, and that the posterior petroclinoid ligament is a candidate structure for causing oculomotor nerve palsy without intracranial hemorrhage and skull fracture．