右頭頂後頭葉出血により輻湊不全型外斜視を発症した1例  [in Japanese] A Case of Exotropia with Convergence Insufficiency due to Right Parieto-occipital Lobe Hemorrhage  [in Japanese]

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Author(s)

    • 蒲生 真里 Gamo Mari
    • 神奈川歯科大学附属横浜クリニック眼科 Department of Ophthalmology, Yokohama Dental and Medical Clinic, Kanagawa Dental College
    • 原 直人 Hara Naoto
    • 神奈川歯科大学附属横浜クリニック眼科|国際医療福祉大学 保健医療学部 視機能療法学科 Department of Ophthalmology, Yokohama Dental and Medical Clinic, Kanagawa Dental College|International University of Health and Welfare Department of Orthoptics and Visual Sciences
    • 君島 真純 Kimijima Masumi
    • 神奈川歯科大学附属横浜クリニック眼科 Department of Ophthalmology, Yokohama Dental and Medical Clinic, Kanagawa Dental College
    • 鈴木 裕美 Suzuki Hiromi
    • 神奈川歯科大学附属横浜クリニック眼科 Department of Ophthalmology, Yokohama Dental and Medical Clinic, Kanagawa Dental College
    • 向野 和雄 Mukuno Kazuo
    • 神奈川歯科大学附属横浜クリニック眼科 Department of Ophthalmology, Yokohama Dental and Medical Clinic, Kanagawa Dental College

Abstract

症例は22歳男性.右頭頂後頭葉領域の脳動静脈奇形による脳出血により,開頭手術直後から複視を自覚し外斜視に気づき,発症2年後に近医より当院眼科へ斜視手術目的で紹介された.第一眼位は右外斜視.動的視野検査で左下1/4半盲を認め,眼球運動は全方向に制限なく,近見反応は輻湊不全がみられ,他覚的調節検査にて特に右眼の調節の減弱を認めた.対光反応は左右眼の差なく正常であった.右外直筋後転術8mmを施行した後,輻湊が可能となり眼位は正位を保つようになった.頭頂後頭葉領域は近見反応にとり重要な領域であり,輻湊不全型外斜視発症の重要な責任領域の可能性があると考えられた.

A 22-year-old man complained of double vision after receiving a craniotomy procedure due to hemorrhage caused by cerebral arteriovenous malformation in the right parieto-occipital area. The patient was referred to us from the hospital for strabismus surgery 2 years after the onset of double vision. He manifested right exotropia with convergence insufficiency. Visual field testing showed a left inferior quadrantanopia. Version eye movement was unrestricted in all directions. Furthermore, accommodative function showed a reduction in the amplitude of accommodation of the right eye, and convergence reaction in the right eye was slightly decreased. However, using an electronic pupillometer, the pupillary light reaction was normal with no difference between the right and the left eye. After undergoing an 8-mm right external rectus muscle recession, convergence became possible and an orthophoric eye position was maintained. The right parieto-occipital area plays an important role in eliciting near reflexes which led us to hypothesize that this area might be responsible for exotropia with convergence insufficiency.

Journal

  • Neuro-Ophthalmology Japan

    Neuro-Ophthalmology Japan 32(4), 377-383, 2015

    The Japanese Neuro-Ophthalmology Society

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