우안 외전신경마비 회복 후 동측 동안신경마비가 발생한 환자 치험 1례 A Case of Occurred Oculomotor Nerve Palsy On the Same Side after Recovery of Abducent Nerve Palsy at Right Eye원문보기
Recurrence of peripheral nerve palsy is unusual, specially in eye. So there's seldom report about recurrent peripheral nerve palsy in eye. We treated a patient who had consecutive oculomotor nerve palsy after recovery of abducent nerve palsy at right eye. The patient visited our clinic for abducent ...
Recurrence of peripheral nerve palsy is unusual, specially in eye. So there's seldom report about recurrent peripheral nerve palsy in eye. We treated a patient who had consecutive oculomotor nerve palsy after recovery of abducent nerve palsy at right eye. The patient visited our clinic for abducent nerve palsy. When he was hospitalized, ophthalmalgia was VAS 4 but it disappeared when he discharged on 21th of June. Although there was, in the case of abduction of eye, no noticeable change during the hospitalization, it was healed after he received outpatient service twice a week until Nov. 3rd. Oculomotor nerve palsy appeared on 24th of November, 2008 and the patient was hospitalized on Nov. 26th. At that time ophthalmalgia was VAS 4, but disappeared when he discharged. When he entered hospital, the length between upper & lower eyelid and MRD 1 were all 0mm. However, when he discharged, the length between upper & lower eyelid was 11mm, and MRD 1, 4mm which were the same lengths as those of the normal left eye. In the case of eye movement, the motion of supraduction, infraduction, and adduction was entirely inhibited when the patient was hospitalized. By the time of discharge, the inhibition of infraduction was recovered after that of adduction, but the inhibition of supraduction was not recovered. This is a very rare case of peripheral nerve palsy, nevertheless he recovered complete twice by acupuncture and herb medicine therapy.
Recurrence of peripheral nerve palsy is unusual, specially in eye. So there's seldom report about recurrent peripheral nerve palsy in eye. We treated a patient who had consecutive oculomotor nerve palsy after recovery of abducent nerve palsy at right eye. The patient visited our clinic for abducent nerve palsy. When he was hospitalized, ophthalmalgia was VAS 4 but it disappeared when he discharged on 21th of June. Although there was, in the case of abduction of eye, no noticeable change during the hospitalization, it was healed after he received outpatient service twice a week until Nov. 3rd. Oculomotor nerve palsy appeared on 24th of November, 2008 and the patient was hospitalized on Nov. 26th. At that time ophthalmalgia was VAS 4, but disappeared when he discharged. When he entered hospital, the length between upper & lower eyelid and MRD 1 were all 0mm. However, when he discharged, the length between upper & lower eyelid was 11mm, and MRD 1, 4mm which were the same lengths as those of the normal left eye. In the case of eye movement, the motion of supraduction, infraduction, and adduction was entirely inhibited when the patient was hospitalized. By the time of discharge, the inhibition of infraduction was recovered after that of adduction, but the inhibition of supraduction was not recovered. This is a very rare case of peripheral nerve palsy, nevertheless he recovered complete twice by acupuncture and herb medicine therapy.
안구는 안와 내의 6개의 외안근에 의해서 움직여지는데 4개의 직근과 2개의 사근이 그것이다. 이 중에서 내직근, 상직근, 하직근, 하사근은 동안 신경(제 Ⅲ 뇌신경)의 지배를 받고 상사근은 활차 신경(제 Ⅳ 뇌신경), 외직근은 외전신경(제 Ⅵ 뇌신경)의 지배를 받는다1) .
내직근, 상직근, 하직근, 하사근은 무엇의 지배를 받는가?
안구는 안와 내의 6개의 외안근에 의해서 움직여지는데 4개의 직근과 2개의 사근이 그것이다. 이 중에서 내직근, 상직근, 하직근, 하사근은 동안 신경(제 Ⅲ 뇌신경)의 지배를 받고 상사근은 활차 신경(제 Ⅳ 뇌신경), 외직근은 외전신경(제 Ⅵ 뇌신경)의 지배를 받는다1) . 외안근의 운동을 담당하고 있는 이 3개의 뇌신경은 다양한 원인에 의해 마비가 발생하고 마비에 따른 임상양상 또한 다양하다.
中醫症狀鑑別診斷學에서 안구운동신경마비를 어떻게 분류했는가?
안구운동신경마비는 한의학에서 神珠將反, 瞳神返背로 불리던 질환이다.5) <中醫症狀鑑別診斷學>에서는 안구운동 신경마비를 風邪中絡, 痰濕阻絡, 風熱上攻, 肝風內動, 瘀血凝滯, 稟賦不足, 偏廢性으로 원인별로 나누었다6) . 특히, 風을 원인으로 보는 경우가 많았으며怒氣가 있는 경우 風의 발생이 쉽다고 하였다.
참고문헌 (24)
윤동호, 이상욱, 최억. 안과학. 서울:일조각. 2007:27.
Wipf MD, Douglas S. Paauw MD. Ophthalmologic emergencies in the patient
Ishikawa H, Yoshihara M, Mizuki K, Kashima Y. A pediatric case of ophthalmoplegic migraine with recurrent oculomotor nerve palsy. Nippon Ganka Gakkai Zasshi. 2000 Mar;104(3):179-82.
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