うっ血乳頭はなく片眼性の視神経乳頭変形，後天性遠視，網脈絡膜皺襞，視神経周囲くも膜下腔拡大を呈した特発性頭蓋内圧亢進症の1例

A case of idiopathic intracranial hypertension with unilateral ocular manifestations, including deformation of the optic nerve head, acquired hyperopia, chorioretinal fold, and dilatation of the subarachnoid space around the optic nerve, without papilledema

要約　背景：頭蓋内圧亢進症の眼合併症は両眼性に発生し，多くはうっ血乳頭がみられやすい。

目的：うっ血乳頭のない片眼性の視神経乳頭変形，後天性遠視，網脈絡膜皺襞，視神経周囲くも膜下腔拡大を呈した特発性頭蓋内圧亢進症の1例を報告する。

症例：36歳，男性。頭痛と左眼痛のため岐阜市民病院（当院）脳神経外科と眼科で精査を受けるも原因となる異常所見は指摘されなかった。2年後，他院と健診で左眼の裸眼視力低下と黄斑前膜を指摘され当院眼科を受診した際，左眼の視神経乳頭変形，後天性遠視，網脈絡膜皺襞，視神経周囲くも膜下腔拡大を認め，頭蓋内異常のない脳脊髄圧上昇を指摘された。特発性頭蓋内圧亢進症の診断にてアセタゾラミドと五苓散を処方された。治療を開始してから1.5年の経過中に新たな病態発生はないが，左眼にみられる異常所見の改善はない。

結論：片眼性であっても網脈絡膜皺襞，乳頭形態異常，後天性遠視などを診たときには頭蓋内圧亢進症も考慮すべきである。

Abstract　Background：Ocular manifestations of intracranial hypertension tend to occur bilaterally, often with papilledema.

Objective：We report a case of idiopathic intracranial hypertension with unilateral ocular manifestations, including deformation of the optic nerve head, acquired hyperopia, chorioretinal fold, and dilatation of the subarachnoid space around the optic nerve, without papilledema.

Case：A 36-year-old male patient presented with headache and left eye pain, but no abnormal findings were identified. Two years later, ophthalmic examination revealed deformation of the optic nerve head, acquired hyperopia, chorioretinal fold, and peripapillary subarachnoid space enlargement in the left eye. He also had elevated cerebrospinal fluid pressure with no intracranial abnormality. He was diagnosed with idiopathic intracranial hypertension and was prescribed Diamox tablets and Kracie Goreisan extract tablets. During the first 1.5 years of treatment, there was no progression of the disease, but there was no improvement in the ocular condition either.

Conclusion：Intracranial hypertension should be considered in the differential diagnoses of unilateral chorioretinal fold, deformation of the optic nerve head, and acquired hyperopia, even in the absence of papilledema.