持弓獵人症候群造惡性陣發性姿態性眩暈症－個案報告

A Case Report of Malignant Paroxysmal Positional Vertigo Caused by ＂Bow-Hunter Syndrome＂

陳建志(Jiann-Jy Chen) ； 陳登郎(Dem-Lion Chen) ； 林巧容(Chiao-Jung Lin)

《台灣老年醫學暨老年學雜誌》 10卷3期 (2015/08) Pp. 191-196

https://doi.org/10.29461/TGG.201508_10(3).0005

摘要

一88歲老年男性，屢屢因頭向右轉時引發陣發性的眩暈長達9個月，起初臆斷為良性陣發性姿態性眩暈症，卻無法為耳石復位術所緩解。彩色動脈超音波及腦部磁振造影證實是右側椎動脈嚴重狹窄，當頭向右轉時會使基底動脈的血流減少，並發現左側橋腦缺血性病變。這種狀況稱之為持弓獵人症候群，在轉頭時會引起椎基底動脈的血流減少，避免轉頭可減少病症的復發。當我們在診治老年患者時，如果陣發性姿態性眩暈症對於耳石復位術的治療反應不好時，就需要密切的探查，考慮是否為小腦橋腦角或內聽道的腫瘤，或是持弓獵人症候群所造成暫時性的前庭神經功能不良。

關鍵字

良性陣發性姿態性眩暈症 ； 惡性陣發性姿態性眩暈症 ； 持弓獵人症候群 ； 椎動脈狹窄 ； 椎基底動脈循環不全

並列摘要

An 88-year-old man has presented with a 9-month history episodic vertigo when he turned his head to the right. Benign paroxysmal positional vertigo was initially suspected, but Epley’s canalith repositioning maneuvers failed to ameliorate the symptom. Carotid duplex and brain magnetic resonance imaging demonstrated right vertebral artery stenosis, and reduction of basilar artery flow by turning his head to the right. An ischemia lesion at the left side of the pons was found. The condition is called ＂Bow-Hunter syndrome＂ which caused diminished vertebrobasilar flow by head turning. Avoidance of head turning led to a decrease in recurrence. In an aged patient, paroxysmal positional vertigo refractory to canalith reposition maneuvers warrants intensive investigation. Besides, cerebellopontine angle or internal acoustic canal tumors, ＂Bow-Hunter syndrome＂ with transient vestibular dysfunction should also be considered.

並列關鍵字

benign paroxysmal positional vertigo ； malignant paroxysmal positional vertigo ； Bow-Hunter syndrome ； vertebral arterial stenosis ； vertebrobasilar insufficiency