内頸動脈瘤による動眼神経麻痺の1症例

A case of oculomotor nerve palsy caused by internal carotid aneurysm

I．はじめに

　動眼神経麻痺は，さまざまな疾患が原因となって発生する眼症状である。原因として，脳動脈瘤，糖尿病・高血圧・動脈硬化による血管障害，外傷，腫瘍，副鼻腔の炎症性疾患や囊胞性疾患などが挙げられ^1），耳鼻咽喉科医にとっても注意すべき臨床症状と考えられる。今回われわれは，副鼻腔炎の存在によって原因疾患の特定が遅れた動眼神経麻痺症例を経験した。本症例の病態について報告するとともに，動眼神経麻痺の診断，治療，鑑別点について文献的考察を行ったので報告する。

A 68-year-old woman had been aware of diplopia for 4 months,and had complained of right-sided severe retro-ocular pain 1 week prior to presentation. On physical examination,she manifested right-sided ocular motor impairment,blepharoptosis,exotropia and mydriasis. CT scan depicted ethmo-sphenoidal sinusitis of the affected side. Endoscopic sinus surgery was performed under a tentative diagnosis of rhinogenous oculomotor nerve palsy,however,her symptoms did not ameliorate. Further examinations by MRI and carotid angiography revealed an internal carotid-posterior communicating artery aneurysm,which was thought to be responsible for her oculomotor nerve palsy. The patient eventually underwent clipping of the aneurysm via anterolateral craniotomy,and complete remission was achieved in a month. The etiology,diagnosis and management of oculumotor nerve palsy were bibliographically reviewed.