片側下四半盲をきたした下垂体卒中の1例

Unilateral quadrantanopia in a case of pituitary apoplexy

要約　目的：片眼に下四半盲が生じた下垂体卒中の症例の報告。症例：50歳男性が前日からの頭痛，左眼の視力障害と眼瞼下垂で受診した。所見：矯正視力は右1.0，左0.2で，左眼に眼瞼下垂，内転と上転障害，中心フリッカ値の低下があった。両眼とも前眼部や眼底に異常はなかった。Goldmann視野検査で，左眼に右下の四半盲に似た所見があった。磁気共鳴画像検査（MRI）でトルコ鞍上部に出血を含む腫瘤があり，視神経と視交叉を上方に圧迫し，下垂体卒中と診断した。10日後に手術を行った。その15日後に視野は正常化し，視力は1.0になり，動眼神経麻痺は消失した。結論：本症例での四半盲は，腫瘍内の出血で拡大した下垂体腫瘍が視交叉後方を圧迫して生じた可能性がある。

Abstract.　Purpose：To report a case of pituitary apoplexy with unilateral inferior quadrantanopia as the initial manifestation. Case：A 50-year-old male presented with headache,impaired visual acuity and blepharoptosis in the left eye since the day before. Findings：Corrected visual acuity was 1.0 right and 0.2 left. The left eye showed blepharoptosis,restricted adduction and upward gaze. There were no abnormal findings in the eyeglobe in either eye. Goldmann perimetry showed findings simulating quadrantanopia in the lower nasal sector in the left eye. Magnetic resonance imaging（MRI）showed a tumor superior to the sella turcica compressing the optic nerve and chiasm upwards. The findings led to the diagnosis of pituitary apoplexy. Surgery was followed by normalized visual field with visual acuity of 1.0. Findings of oculomotor palsy disappeared. Conclusion：Unilateral quadrantanopia appears to have been caused by pituitary tumor with intratumor hemorrhage,or pituitary apoplexy,that compressed the posterior portion of optic chiasm upwards.