속목동맥 폐쇄의 치료를 위한 혈전제거술 후 발생한 안와경색증후군 = Orbital Infarction Syndrome after Thrombectomy for Internal Carotid Artery Occlusion

다국어 초록 (Multilingual Abstract)

Purpose: To report a case of orbital infarction syndrome after thrombectomy for internal carotid artery (ICA) occlusion.
Case summary: A 69-year-old female with a history of diabetes mellitus and hypertension was referred to our clinic because of acute right ocular pain and visual disturbance. The patient had a history of a right middle cerebral artery territory infarction following right ICA occlusion and her ocular symptoms developed 6 hours after thrombectomy treatment. The visual acuity was hand motion in the right eye and 20/20 in the left eye. Pupil dilation and a relative afferent pupillary defect were seen in her right eye. There was ptosis of the right eyelid, and the ocular motility examination showed all gaze limitations in the right eye. In fundus examinations, multiple white focal ischemic retinal lesions were observed in the right eye suggesting branch retinal artery occlusion. Slit lamp examination showed chemosis in the right eye. The patient was diagnosed with ocular infarction syndrome due to micro-thromboembolism of the ophthalmic artery which developed after the thrombectomy.
Conclusions: Orbital infarction syndrome can occur after thrombectomy. Therefore, it is necessary to consider the development of orbital infarction when patients present with sudden-onset ocular pain, visual loss, and ocular movement limitations after the procedure.

국문 초록 (Abstract)

목적: 속목동맥 폐쇄의 치료를 위한 혈전제거술 후 발생한 안와경색증후군을 경험하였기에 이를 보고하고자 한다.
증례요약: 당뇨, 고혈압의 병력이 있던 69세 여자 환자가 신경외과에서 우측 중대뇌동맥 경색 및 우측 속목동맥의 폐쇄로 혈전제거술을 받은 후 6시간 뒤부터 갑자기 발생한 우측 안구통증 및 시력저하를 주소로 안과에 의뢰되었다. 최대교정시력은 우안 안전수동, 좌안 20/20이었고, 동공반응검사에서 우안의 상대구심동공운동장애가 관찰되었다. 우안의 눈꺼풀처짐과 우안의 전 방향의 안구운동장애가 관찰되었다. 세극등현미경검사에서 우안의 결막부종이 관찰되었으며, 안저검사에서 우안의 망막에 허혈로 인한 다발성의 국소창백 병변이 관찰되어 망막동맥폐쇄가 발생하였음을 알 수 있었다. 혈관조영에서 안동맥의 혈류 지체 소견이 관찰되었다. 급성으로 나타난 상기 안과 증상 및 검사 소견을 종합하여 속목동맥의 혈전제거술 후 발생한 안동맥의 미세혈전색전증으로 인한 안와경색증후군으로 진단하였다.
결론: 안와경색증후군은 혈전제거술의 합병증으로써 발생할 수 있다. 따라서 시술 후 환자가 갑작스러운 안통, 시력저하 및 안구운동장애를 호소한다면 안와경색증후군의 발생을 염두에 둘 필요가 있다.

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