合併偏頭痛性眩暈之美尼攸氏病

Ménière's Disease Associated with Migrainous Vertigo

陳建志(Jiann-Jy Chen) ； 孫盛義(Sheng-Yih Sun) ； 陳登郎(Dem-Lion Chen)

《北市醫學雜誌》 6卷5期 (2009/10) Pp. 391-397

https://doi.org/10.6200/TCMJ.2009.6.5.06

摘要

反覆發作的眩暈、耳鳴及聽障不僅可能是美尼攸氏病，也可能是偏頭痛性眩暈，這兩種疾病的鑑別診斷著實是一個挑戰。－49歲男性，過去罹患無預兆偏頭痛。近4年來，雖然不再發作偏頭痛，卻苦於反覆發作的眩暈及右側耳鳴。理學檢查呈現向右注視性眼振，一前一後步伐測試會向左傾倒。聽力檢查顯示右耳聽閾上升，右耳複響測試為陽性，但語音辨識度為100%。血管磁振造影顯示兩側後交通動脈缺乏及椎基底動脈彎曲，尚無其他腦部之異常。雖然診斷為美尼攸氏病，但由於病症發作時，會合併視力模糊、噁心、嘔吐、畏光及畏聲等偏頭痛症狀，且發作後眼振電圖及前庭誘發肌性電位呈現中樞性障礙，本個案亦應為偏頭痛性眩暈。每每於保守治療後病症緩解，追蹤迄今已半年，情況依然穩定。

關鍵字

無預兆偏頭痛 ； 美尼攸氏病 ； 偏頭痛性眩暈

並列摘要

Episodes of vertigo, tinnitus and hearing impairment are not only thought of Ménière's disease (MD), but also migrainous vertigo (MV). The differentiation between MD and MV is really a clinical challenge. A 49-year-old male had suffered from migraine without aura in the past. He had been bothered by episodes of vertigo and right tinnitus without headaches over the last four years. Physical examination showed right beating gaze nystagmus and abnormal tandem gait with tilting to left side. Audiometry showed right increased hearing thresholds in each frequency tested, and there was a right positive recruitment test; however, right speech discrimination score was 100%. A magnetic resonance angiogram showed the absence of bilateral posterior communicating arteries and tortuosity of the vertebral-basilar artery. Migrainous symptoms, such as blurred vision, nausea, vomiting, photophobia, and phonophobia were noted at each attack, and an electronystagmogram and vestibular evoked myogenic potential indicated central impairment after an attack. Accordingly, not only MD, but also MV was diagnosed. The symptoms would subside each time after conservative treatment. The following half year follow-up was uneventful.

並列關鍵字

migraine without aura ； Ménière's disease ； migrainous vertigo