당뇨 환자에서 발생한 비전형적인 허혈성 뇌신경마비 = Atypical Ischemic Cranial Nerve Palsy in a Diabetic Patient

다국어 초록 (Multilingual Abstract)

Purpose: We report an atypical case of ischemic oculomotor palsy occurring sequentially in both eyes and then improving, followed by a new abducens palsy in a diabetic patient with poor blood sugar control.
Case summary: A 51-year-old woman presented with diplopia, dizziness, and pain in the right eye and was diagnosed with oculomotor palsy in the right eye. Magnetic resonance imaging of her brain was normal but glycated hemoglobin concentration was 13.4%. After 2 months, the third nerve palsy in the right eye had recovered completely but a new third nerve palsy occurred in the left eye. 1 month later, the symptoms had improved, and the patient did not return to our clinic until 18 months later, when she returned with new diplopia. This time, she was diagnosed with a sixth nerve palsy in the left eye and was observed while controlling her blood sugar. She recovered after 4 months.
Conclusions: Generally, cranial nerve palsies occur unilaterally in situations that can cause ischemia, such as diabetes, high blood pressure, and hyperlipidemia. Rarely, they occur bilaterally, or two or more cranial nerve palsies occur simultaneously.
However, it is very rare that cranial nerve palsy occurs sequentially in both eyes under the same systemic blood sugar control.
Diabetic patients with poor blood sugar control require long-term monitoring, considering the possibility of symptoms developing in both eyes with a time lag or other forms of ischemic cranial nerve palsy.

국문 초록 (Abstract)

목적: 혈당 조절이 불량한 당뇨 환자에서 양안에 순차적 허혈성 동안신경마비가 발생하고 호전된 후 새롭게 단안 외전신경마비가발생한 비전형적 증례를 보고하고자 한다.
증례요약: 51세 여환이 우안 통증, 어지럼증, 복시를 주소로 본원 안과에 내원해 우안 동안신경마비로 진단하였다. 당화혈색소가13.4%로 높아 내분비내과 협진 하에 경과 관찰하여 2개월 뒤 우안 동안신경마비는 회복되었으나 새롭게 좌안 동안신경마비가 발생하였고 한달 후 증상이 나아져 환자는 내원하지 않았다. 18개월 후 새로운 복시 증상을 주소로 재내원하여, 좌안 외전신경마비로 진단및 혈당 관찰하여 4개월 후 증상 소실되었다.
결론: 당뇨는 허혈성 뇌신경마비의 중요 원인이며 대부분 편측성이지만 간혹 양측성으로 나타나거나 편측으로 여러 뇌신경마비가일어나기도 한다. 하지만 비슷한 전신 상태에서 양안에 순차적으로 발생후 회복 시기가 다르며 뇌신경마비가 완전 회복되고 1년이넘는 기간 후 새로운 뇌신경마비가 발생하는 경우는 드물다. 이렇듯 혈당 조절이 불량한 당뇨 환자에서는 시간차를 두고 양안으로발현되거나, 뇌신경마비가 회복된 후 다른 양상의 뇌신경마비의 발생 가능성을 염두하고 장기적 경과 관찰이 필요하다.

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