전신마취수술 이후 발생한 양측 후대뇌동맥 폐쇄에 의한 피질맹 2예

Two Cases of Cortical Blindness from Both Posterior Cerebral Artery Occlusion Following General Anesthesia Surgery

목적: 전신마취하 척추수술 및 위암수술 후 양측 후대뇌동맥 폐쇄에 의한 피질맹이 발생한 증례 2예를 보고하고자 한다. 증례요약: (증례 1) 65세 남자 환자가 전신마취하에 척추수술 후 4일째 시력저하가 발생하였다. 시력은 양안 안전수동이었으며, 대광반사, 상대구심동공운동장애, 세극등현미경, 안저검사는 정상이었다. 뇌 컴퓨터단층촬영 및 자기공명영상에서 후대뇌동맥 부위의 경색 소견이 확인되었다. 시야검사상 양안 동측성 좌측 반맹과 우측 상사분맹이 남았다. (증례 2) 64세 남자 환자가 전신마취하에 복강경 위절제술 시행 후 회복실에서 시력저하를 호소하였다. 시력은 우안 안전수지, 좌안 안전수동이었으며, 대광반사, 상대구심동공운동장애, 세극등현미경, 안저검사는 정상이었다. 뇌 자기공명영상에서 양측 후대뇌동맥 영역의 경색 소견이 확인되었다. 시야검사상 양안동측성 좌측 반맹과 우측 하사분맹으로 나타났으며, 추적 관찰 2년째에도 회복되지 않았다. 결론: 시력과 무관한 부위의 수술 후에 발생한 피질맹은 예측하기가 어렵고, 예후가 매우 불량하며 치명적인 합병증이다. 전신마취하수술 후 발생할 수 있는 시기능 저하의 위험 요인에 대한 연구와 이를 예방하기 위한 노력이 필요할 것이다.

Purpose: To report two rare cases of cortical blindness resulting from posterior cerebral artery (PCA) occlusion after laminectomy and laparoscopic gastrectomy under general anesthesia. Case summary: (Case 1) A 65-year-old man presented with visual loss after a bone graft and total laminectomy for spinal stenosis under general anesthesia. His best-corrected visual acuity (BCVA) was hand motion in both eyes. The pupillary light reflex was normal, and a relative afferent pupillary defect (RAPD) was not observed. Slit-lamp microscopy and fundus examination were normal. Using brain computed tomography, magnetic resonance imaging (MRI), and angiography, a PCA infarction was detected. His left 2b PCA was reperfused after intra-arterial thrombolysis. However. he still had left homonymous hemianopia and right homonymous superior quadrantanopia. (Case 2) A 64-year-old man was referred for visual loss in the recovery room after laparoscopic distal gastrectomy under general anesthesia. His BCVA was finger counting for the right eye and hand motion for the left eye. His pupillary light reflex was normal. A RAPD was not observed. Slit-lamp microscopy and a fundus examination were normal. Using a brain MRI and angiography, PCA infarctions were detected. Echocardiography showed an atherosclerotic change with a mobile plaque. Anticoagulation therapy was started, but he still had left homonymous hemianopia and right homonymous inferior quadrantanopia. Conclusions: Cortical blindness caused by non-ophthalmological surgery under general anesthesia is known for severe complications and poor prognoses. Therefore, it is crucial to identify patients with high risks of complications to prevent ophthalmic complications resulting in visual losses before surgery.