후천제삼뇌신경마비의 임상양상과 자연경과

Clinical Features and Course of Acquired Third Cranial Nerve Palsy

목적: 후천제삼뇌신경마비의 원인별 분포와 임상양상 및 자연경과를 알아보고자 하였다. 대상과 방법: 2016년 3월부터 2019년 12월까지 삼성창원병원 안과에서 후천제삼뇌신경마비로 진단된 환자 중 3개월 이상 추적 관찰이 가능하였던 40명을 대상으로 임상양상 및 자연경과를 후향적으로 분석하였다. 결과: 발병 시 평균연령은 64.6 ± 15.9세, 평균 추적 관찰 기간은 4.4 ± 8.4개월이었다. 원인별로는 미세혈관성 원인이 12명(30.0%), 뇌혈관질환(뇌출혈, 뇌경색, 뇌동맥류) 및 종양이 각각 8명(20.0%)을 차지하였다. 완전 회복은 27명(67.5%)에서 관찰되었고, 다른 뇌신경마비가 동반된 비단독제삼뇌신경마비가 12명(30.0%)으로, 이 중 제육뇌신경마비의 동반이 8명(66.7%)으로 가장 많았다. 회복군에서는 미세혈관성 원인 12명(42.9%), 지속군에서는 종양이 8명(66.7%)으로 가장 많았으며(p<0.001), 초진 시 안구운동제한 정도가 회복군(-2.4 ± 1.1)에서 지속군(-3.2 ± 0.6)보다 더 작았으며 통계학적으로 유의미하게 나타났다(p=0.039). 동공 침범은 미세혈관성제삼뇌신경마비 환자 중 1명(8.3%)에서, 압박제삼뇌신경마비 환자 중 8명(61.5%)에서 나타났다. 결론: 후천제삼뇌신경마비에서 미세혈관성 원인이거나 초진 시 안구운동제한 정도가 경할수록 회복률이 높았다. 그리고 압박성 뇌병변에서 높은 동공 침범률을 보이지만, 동공 침범 여부만으로 원인 질환을 감별하기보다는 필요 시 영상검사의 시행을 고려해야할 것이다.

Purpose: The purpose of our study was to investigate the clinical features and course of acquired third cranial nerve (CN3) palsy. Methods: We retrospectively reviewed the medical records of 40 consecutive patients who underwent at least 3 months of follow- up clinical evaluation from March 2016 to December 2019 who were admitted to the ophthalmologic department or referred from other departments of Samsung Changwon Hospital and diagnosed with acquired CN3 palsy. Results: The average age of patients with acquired CN3 palsy was about 64.6 ± 15.9 years and the mean follow-up period was 4.4 ± 8.4 months. Microvasculopathy (twelve patients, 30.0%) was the most common etiology followed by brain vascular lesions (eight patients, 20.0%), and tumors (eight patients, 20.0%). The complete recovery rate was 67.5% and non-isolated CN3 palsy was recorded in 30.0% cases of which six cranial nerve palsy (in eight patients, 66.7%) was the most common. Microvasculopathy (42.9%) and tumors (66.7%) were the most common features in the recovery and persistent groups, respectively. Extraocular movement limitation at the first visit was smaller in the recovery group (&#8722;2.4 ± 1.1) than in the persistent group (&#8722;3.2 ± 0.6); the difference was statistically significant (p = 0.039). Pupil involvement was found in one (8.3%) patient from the microvascular group and in eight (61.5%) patients from the compressive lesion group. Conclusions: The microvascular group or those with a low degree of extraocular movement limitation at the first visit had the highest recovery rate in acquired CN3 palsy. Although compressive lesions showed high pupillary involvement, imaging study should be considered for confirmation rather than attempting to discriminate the causative disease based solely on pupil involvement.