Tolosa-Hunt症候群に視神経炎を合併し著明な視力低下をきたした1例

A case of Tolosa-Hunt syndrome with optic neuritis and impaired visual acuity

目的：視神経炎と視力低下が生じたTolosa-Hunt症候群1例の報告。症例と経過：31歳女性が左眼深部痛で受診した。矯正視力は右1.2，左0.8であった。4日後に左眼視力が0.08に低下し全眼球運動麻痺が生じた。Tolosa-Hunt症候群に併発した視神経炎と診断した。ステロイドパルス療法で眼痛と眼球運動障害が軽快し視力は0.7に改善したが，ステロイド中止直後に再悪化し視力0になった。再度のステロイドパルス療法とプレドニゾロン内服で病状は軽快した。以後9か月間に再発はない。結論：ステロイドパルス療法後のプレドニゾロン内服はTolosa-Hunt症候群での視神経炎の再発防止に有用であった。

Purpose：To report a case of Tolosa-Hunt syndrome with optic neuritis and impaired visual acuity. Case and Findings：A 31-year-old woman presented with retrobulbar pain in her left eye. Her corrected visual acuity was 1.2 right and 0.8 left. The left eye developed total ophthalmoplegia with visual acuity of 0.08 four days later. She was diagnosed with Tolosa-Hunt syndrome with optic neuritis. Pulsed corticosteroid therapy induced improved ocular motility with reduced pain. Visual acuity improved to 0.7. Discontinuation of corticosteroid was followed by severe recurrence. Left visual acuity was reduced to no light perception. Another course of pulsed corticosteroid therapy with peroral prednisolone induced improvement. There has been no recurrence until 9months later. Conclusion：Pulsed corticosteroid therapy with peroral prednisolone may be useful in preventing recurrence of optic neuritis in Tolosa-Hunt syndrome.