급성산재성뇌척수염(Acute disseminated encephalomyelitis)에 의한 시신경염 1예

• Published in: Daihan angwa haghoi jabji Vol. 44; no. 5; pp. 1237 - 1241
• Main Authors: 이준모, Jun Mo Lee, 신인하, In Ha Shin, 서경률, Kyoung Yul Seo
• Format: Journal Article
• Language: Korean
• Published: 대한안과학회 15.05.2003
• Subjects: Acute disseminated encephalomyelitis; ADEM; MDEM; Multiphasic disseminated encephalomyelitis; Multiple sclerosis; Optio neuritis
• ISSN: 0378-6471

목적 : 저자들은 국내에서 보고되지 않은 급성산재성뇌척수염에 의한 시신경염을 경험하고, 이를 보존적 방법으로 치료하였기에 보고하는 바이다. 대상과 방법 : 7년 7개월된 아이가 두통과 양안의 시력저하를 주소로 본원 안과 외래로 내원하였다. 내원당시 양안시력은 광각무였고, 동공반사는 우안에선 무반응이었으나, 좌안에선 약한 반응을 보였으며, 구심성동공운동장애가 양안에서나타났고, 안저검사에서 양안에 유두부종소견을 보였다. 핵자기공명영상촬영에서 양측대뇌반구의 피질과 피지하부를 다핵구세포 10, 단핵구세포 8 cell/㎣이었다. 결과 : 급성산재성뇌척수염 진단하에 Steroid Pluse Therapy로써 Methylprednisolone Sodium Succinate (Solu-Medrol^?, Pharmacia, U.S.A)를 30㎎/㎏ 용량으로 정맥주사하고, 면역글로불린(Liv gamma^?, Green cross, Korea)을 1g/㎏ 용량으로 정맥주사하였다. 7일간의 부신피질호르몬 정맥주사 후 경구 부신피질호르몬으로 감량을 시작하였고, 나안시력은 우안 0.9 좌안 0.9로 호전되었으며, 구심성동공운동장애가 양안에서 소실되었고, 시신경유발전위 검사는 양안에서 정상소견이었다. Purpose: This case is the first report of optic neuritis f311owing acute disseminated encephalomyelitis in Korean literature and we report this case with a successful result of conservative treatment. Methods: We examined a 7-year and-7-month-old female patient who visited our ophthalmology clinic complaining of a headache and visual disturbance in both eyes. At the time of visit, light perception was negative in both eyes, response to light reflex was nil in the right eye and weak in the left eye. Relative afferent papillary defect (RAPD) was noted in both eyes, and the disc swelling was found in both eyes on fundus examination. MRI brain scans revealed asymmetrical multifocal lesions involving the cortex and subcortex in the bilateral brain hemispheres, and contrast enhanced in 72-weighted images. Cerebrospinalfluid (CSF) examination showed results of 45 WBC, 10 polynuclear lymphocyte, and 88 monocyte cells/㎣. Results: As patient was diagnosed with acute disseminated encephalomyelitis, she was prescribed intravenous steroid pulse therapy with methylprednisolone sodium succinate (Solu-medrol^?, Pharmacia, U.S.A), and immunoglobulin (Liv gamma^?, Green Cross, Korea). Seven days of steroid therapy was 1311owe0 by tapering with oral steroid. Uncorrected vision was 0.9 in the right eye and 0.9 in the left. RAPD was resolved in both eyes. Visual evoked potentials showed both eyes being normal.