Lee Jong-Min, Kim Sin-Hoo, Lee Jeong-Il, Ryou Ji-Yong, Kim Sook-Young
Department of Ophthalmology, College of Medicine, Catholic University of Daegu, Daegu, Korea.
Korean J Ophthalmol. 2009 Sep;23(3):228-31. doi: 10.3341/kjo.2009.23.3.228. Epub 2009 Sep 9.
We report a case of acute comitant esotropia in a child with a cerebellar tumor. A 3-year-old boy was referred for management of a 9 month history of acute acquired comitant esotropia. On first presentation, the patient's angle of esodeviation was 50 prism-diopters (PD) at distance and near fixation without any lateral incomitance. The cycloplegic refraction revealed +0.75 diopters in both eyes. Very mild bilateral papilledema was found on the fundus examination, but the neurological examination did not reveal any other pathological findings. Brain MRI showed a 5 cm mass located in the midline of the cerebellum as well as hydrocephalus. The mass was completely excised and histological examination confirmed the diagnosis of pilocytic astrocytoma. Despite neurosurgery, the patient's strabismus remained unresolved. One year after neurosurgery, both medial rectus muscles were surgically recessed by 6 mm, resulting in esotropia of 8PD at distant and near fixation without restoration of bifoveal fusion at follow-up 2 years after the eye muscle surgery. Therefore, acute onset comitant esotropia in a child can be the first sign of a cerebellar tumor, even without any other neurological signs and symptoms.
我们报告了一例患有小脑肿瘤的儿童急性共同性内斜视病例。一名3岁男孩因9个月的急性后天性共同性内斜视病史前来就诊。初诊时，患者远距离和近距离注视时内斜视角均为50三棱镜度（PD），无任何外展受限。睫状肌麻痹验光显示双眼均为+0.75屈光度。眼底检查发现非常轻微的双侧视乳头水肿，但神经系统检查未发现任何其他病理表现。脑部磁共振成像（MRI）显示小脑中线有一个5厘米的肿块以及脑积水。肿块被完全切除，组织学检查确诊为毛细胞型星形细胞瘤。尽管进行了神经外科手术，但患者的斜视仍未解决。神经外科手术后一年，双侧内直肌均手术后退6毫米，术后2年随访时，远距离和近距离注视时出现8PD的内斜视，且双黄斑融合未恢复。因此，儿童急性起病的共同性内斜视可能是小脑肿瘤的首发症状，即使没有任何其他神经系统体征和症状。
