外転神経麻痺を初発とし，うっ血乳頭，全身所見を呈した肥厚性硬膜炎の1例

Abducens palsy as the initial symptom in a case of hypertrophic pachymeningitis with choked disc and systemic manifestations

要約　目的：外転神経麻痺で初発し，うっ血乳頭と全身症状を呈した肥厚性硬膜炎の症例の報告。症例：67歳男性が数週間前に突発した複視で受診した。6年前に肺結核と診断された。所見：視力は右1.0，左1.2で，左眼に外転神経不全麻痺があった。磁気共鳴画像検査（MRI）で頭蓋内病変は否定された。プリズム眼鏡で複視は消失したが，発症から4か月後に右外転神経麻痺と上転障害が生じた。8か月後にめまい，ふらつき，頭痛，けいれんなどが生じた。10か月後にうっ血乳頭が両眼に生じ，造影MRIで肥厚性硬膜炎と診断した。ステロイドのパルス療法で1か月後に眼底が正常化し，全身症状も軽快したが，左滑車神経麻痺が残った。結論：眼の運動神経麻痺が非典型的な経過をとるときには，肥厚性硬膜炎が原因である可能性がある。

Abstract.　Purpose：To report a case of hypertrophic pachymeningitis with abducens palsy as the initial manifestation. Case：A 67-year-old male presented with diplopia since the several weeks. He had been diagnosed with pulmonary tuberculosis 6 years before. Findings：Corrected visual acuity was 1.0 right and 1.2 left. Abducens paresis was present in the left eye. No intracranial lesion was detected by magnetic resonance imaging（MRI）. Diplopia was relieved by wearing prism spectacles. He developed abducens palsy and impaired sursumduction in the right eye 4 months later. Vertigo,headache and convulsion developed another 4 months later followed by choked disc. Contrast-enhanced MRI led to the diagnosis of hypertrophic pachymeningitis. Pulsed corticosteroid therapy was followed by remission except left trochlear palsy. Conclusion：This case illustrates that ocular motor palsy with atypical clinical course may be due to hypertrophic pachymeningitis.