摘要
面對有偏頭痛病史而反覆發作眩暈、耳鳴及聽障患者時，鑑別美尼攸氏病或偏頭痛性眩暈實爲一個難題。一52歲女性，有基底型偏頭痛之過去病史，也曾因左側青光眼接受左側虹膜雷射切開手術。在基底型偏頭痛停止發作4年後，竟於5個月內反覆發作共計5次之眩暈、左側耳鳴及左側聽障。純音聽力檢查顯示左側250 Hz處之聽閾在發病時會上升，可能是基底型偏頭痛所致之延遲性美尼攸氏病。然而，發作前會有近暈厥感及視覺預兆，理學檢查、眼振電圖及前庭誘發肌性電位檢查顯示應同時有中樞性的障礙，血管磁振造影顯示威利氏環不完整，擴散加權顯影顯示腦幹與小腦處顯影增加，也可能是不伴隨頭痛之典型預兆所致之偏頭痛性眩暈。建議長期服用安眠藥治療失眠及抗血小板劑避免後顱窩循環缺血的風險，爾後半年，情況依然穩定。本個案尚須長期追蹤以確立究竟是美尼攸氏病、偏頭痛性眩暈或兩者兼具。
並列摘要
It is a challenge to differentiate between Ménière disease (MD) and migrainous vertigo (MV) in he who with past history of migraine and then with frequent episodes of vertigo, tinnitus and hearing block. A 52-year-old female had a past history of basilartype migraine (BTM). She had received left laser iridectomy because of left glaucoma. Four years after BTM subsided, she has been bothered with 5 attacks of vertigo, left tinnitus and left hearing block in 5 months. Pure tone audiometry revealed the hearing threshold increased over 250 Hz when attack. Delayed MD of BTM was impressed. However, near-fainting and visual aura has been noted before each attack. Physical examination, electronystagmogram, and vestibular evoked myogenic potential showed a central impairment. Magnetic resonance angiogram showed defects of circle of Willis, and diffusion weighted image showed increase intensity of brainstem and cerebellum. Therefore, migrainous vertigo of typical aura without headache was impressed. A hypnotic and anti-platelet were respectively recommended to treat insomnia and prevent the risk of posterior circulation insufficiency. In the following half a year, it was uneventful. She will be followed to confirm if she suffers MD, MV, or both.
延伸閱讀
- 陳建志、劉智仰、孫盛義、陳登郎（2010）。美尼攸氏病或突發性耳聾可能是偏頭痛之前驅症狀－病例報告。若瑟醫護雜誌，4(1)，58-64。https://doi.org/10.30145/STJHMNJ.201006.0006
- 陳建志、莊毓民、楊菁華、陳登郎（2009）。可能為偏頭痛前驅症狀之頭暈。澄清醫護管理雜誌，5(2)，41-46。https://doi.org/10.30156/CCMJ.200904.0006
- Wang, C. T. (2008). 從臨床流行病學與神經耳科學來探討與偏頭痛相關之眩暈及頭暈 [master's thesis, National Taiwan University]. Airiti Library. https://doi.org/10.6342/NTU.2008.00704
- 陳建志、劉智仰、陳登郎、楊菁華（2010）。良性陣發性姿態性眩暈症與典型預兆非偏頭痛性頭痛。童綜合醫學雜誌，4(1)，42-48。https://www.airitilibrary.com/Article/Detail?DocID=20713592-201006-201101270002-201101270002-42-48
- 張惠茹、郭嘉琪、白佳玉、吳貞鋆（2017）。Urgent Nursing Experience of a Steven-Johnson syndrome Patient Complicated with Toxic Epidermal Necrolysis。領導護理，18(4)，34-47。https://doi.org/10.29494/LN.201712_18(4).0004