糖尿病合併下垂体卒中患者における動眼神経麻痺の鑑別に3D-FIESTA MRIが有用であった1例

Detection of Oculomotor Nerve Compression by 3D-FIESTA MRI in a Patient with Pituitary Apoplexy and Diabetes Mellitus

Ⅰ．はじめに

　動眼神経麻痺の原因は，脳動脈瘤，脳腫瘍，内頚動脈海綿静脈洞瘻，炎症，糖尿病など多岐にわたる⁸⁾．内科疾患に起因するものは原疾患の治療が重要であるが，下垂体卒中による動眼神経麻痺は可及的早期の手術が症状の改善に寄与するとの報告が多い^1,3,4,8,9)．長期間の糖尿病を有する下垂体卒中患者に生じた動眼神経麻痺の原因を鑑別するために，three-dimensional-fast imaging employing steady-state acquisition（3D-FIESTA）MRIを用いて，動眼神経の圧迫を明瞭に描出し得た症例を経験した．文献的考察を加えて報告する．

　We report the usefulness of 3D-FIESTA magnetic resonance imaging（MRI）for the detection of oculomotor nerve palsy in a case of pituitary apoplexy. A 69-year-old man with diabetes mellitus presented with complete left-side blepharoptosis. Computed tomography of the brain showed an intrasellar mass with hemorrhage. MRI demonstrated a pituitary adenoma with a cyst toward the left cavernous sinus, which was diagnosed as pituitary apoplexy. 3D-FIESTA revealed that the left oculomotor nerve was compressed by the cyst. He underwent trans-sphenoid tumor resection at 5 days after his hospitalization. Post-operative 3D-FIESTA MRI revealed decrease in compression of the left oculomotor nerve by the cyst. His left oculomotor palsy recovered completely within a few months. Oculomotor nerve palsy can occur due to various diseases, and 3D-FIESTA MRI is useful for detection of oculomotor nerve compression, especially in the field of parasellar lesions.