眼筋麻痺後に前部虚血性視神経症をきたした側頭動脈炎の1例

Anterior ischemic optic neuropathy following ocular muscle paresis in a case of temporal arteritis

（B6-1-13）　眼筋麻痺後に両眼の前部虚血性視神経症が出現した側頭動脈炎症例を報告した。症例は86歳の男性で，右眼の軽度の外転制限出現後に発熱し，解熱後激しい頭痛，咀嚼痛，両眼の急激な視力低下が出現した。初診時両眼の視神経乳頭の蒼白浮腫が認められ，前部虚血性視神経症と診断した。赤沈の著明な亢進と浅側頭動脈の腫脹と圧痛から側頭動脈炎を疑い，プレドニゾロン50mgの内服を開始した。同時に施行した浅側頭動脈の生検で，巨細胞性動脈炎の所見が確認された。赤沈の正常化に伴い頭痛も消失し，視力も両眼ともわずかに改善した。高齢者で，特に軽度の眼筋麻痺をみた時は，側頭動脈炎も念頭に置いて注意深い経過観察が必要である．

A 86-year-old male developed abducens paresis followed by high fever. Severe headache, jaw claudication and bilateral visual loss developed 3 weeks later. We diagnosed him as bilateral anterior ischemic optic neuropathy. He also showed swelling and tenderness of bilateral temporal arteries, elevated erythrocyte sedimentation rate (ESR) and increase in C- reactive protein (CRP). Biopsy of temporal artery showed histological features of giant cell arteritis. Systemic treatment with prednisolone at the daily dosis of 50 mg induced immediate cure of headache and gradual normaliza-tion of ESR and CRP values. The visual acuity showed slight improvements, from light perception to hand movement right and from 0.4 to 0.7 left. This case illustrates that temporal arteritis may be involved in patients with diplopia due to oculomotor paresis. Systemic corticosteroid may prevent further progression of optic nerve involvement.