以陣發性眩暈及醒覺幻覺爲表徵之基底動脈狹窄

Basilar Artery Stenosis Masquerading as Episodic Vertigo and Hypnopompic Hallucination

陳建志(Jiann-Jy Chen) ； 劉智仰(Chih-Yang Liu) ； 楊菁華(Chin-Hua Yang) ； 陳登郎(Dem-Lion Chen)

《台灣老年醫學暨老年學雜誌》 4卷2期 (2009/05) Pp. 143-149

https://doi.org/10.29461/TGG.200905.0006

摘要

基底動脈狹窄會以陣發性眩暈爲表徵。一位77歲男性，苦於陣發性眩暈合併醒覺幻覺已經1年，從蹲踞姿勢突然站起測試爲陽性，但姿態變化之血壓測試爲陰性。心電圖、頸椎X光、血液學檢查均爲正常，顱外頸部動脈超音波檢查顯示頸總動脈、內頸動脈及椎動脈之血行動力學有變化。血管磁振造影顯示兩側內頸動脈扭曲，左側頸動脈分叉處、基底動脈與兩側顱內椎動脈均出現了狹窄，擴散加權造影顯示中腦處顯影增加。建議繼續服用抗血小板劑及腦循環促進劑，並調整生活習慣，不建議使用抗眩暈藥。兩個月後，症狀消失，爾後1年，情況依然穩定。年長者全身性疾病較多，在診療其眩暈時，須有完整的病史回顧及檢查，必要時可尋求神經學專家之協助，若懷疑有中樞血管病變時，當安排影像學的檢查，方可找出真正的病因以給予適切的治療。

關鍵字

基底動脈 ； 醒覺幻覺 ； 陣發性眩暈

並列摘要

Basilar artery (BA) stenosis may masquerade as episodic vertigo. A 77-year-old male suffered from episodic vertigo and hypnopompic hallucination for one year. The result of squat-to-stand test was positive while that of postural hypotension test was negative. Results of electrocardiogram, cervical spine X-ray, and blood examinations were normal. Extracranial neck duplex scanning showed hemodynamic changes of common carotid arteries (CCA), internal carotid arteries (ICA) and vertebral arteries (VA). Magnetic resonance angiogram indicated bilateral tortuous ICAs; moreover, stenosis of left CCA bifurcation, BA, and bilateral intracranial VAs were noted. Diffusion weighted image showed increase intensity of midbrain. The patient was accordingly advised to keep taking antiplatelet and brain circulatory promoter, cease taking anti-vertigo drug, and to change his lifestyle. Two months later, symptoms subsided, and the patient remained stable in the following one year. Since the elderly tend to experience various systemic diseases, when vertigo is diagnosed, comprehensive history-review and careful examinations are needed, and neurologic consultation is recommended to find the etiology and the appropriate treatment. If central vascular lesion is suspected, image study is recommended.

並列關鍵字

basilar artery ； hypnopompic hallucination ； episodic vertigo