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Abstracts


一50歲男性,罹患高血壓已經10年,屢屢因頭向左轉引起陣發性的頭暈已經7年,某日因頭暈持續,合併噁心超過1日而求診。眼振電圖顯示兩側視運動性眼振表現不良且頻次減少。腦部磁振造影無異常發現,但血管磁振造影顯示左側椎動脈發育不全,穿顱彩色動脈超音波檢查顯示頭向左轉時可使右側椎動脈及基底動脈的血流速變慢。診斷為椎動脈發育不全併發獵弓症候群,引起兩側橋腦凝視中心、內側縱束及外旋神經核功能不良。建議服用抗血小板劑及生活習慣調整以防止復發。由於獵弓症候群臨床上並不多見,大部分的第一線醫師對此病並不熟悉;嚴重時會併發腦幹或小腦症狀,有的會被誤認是美尼爾氏病;倘若與良性陣發性姿態性眩暈症共同致病時,會更加難以分辨。

Parallel abstracts


A 50-year-old man with a 10-year history of hypertension has been bothered by episodic dizziness induced by leftward head rotation for 7 years. Persistent dizziness and nausea lasting for over 24 hours brought him to the hospital the other day. Electronystagmogram indicated poor bilateral optokinetic nystagmus. Brain magnetic resonance image identified no irregularity, while magnetic resonance angiography showed left vertebral arterial hypoplasia. Transcranial color-coded Doppler scans showed that the blood flow velocities of basilar and right vertebral arteries were slowed down by leftward head rotation. He was diagnosed with vertebral arterial hypoplasia with Bow Hunter's syndrome (BHS) leading to impairment in bilateral pontine gaze centers, medial longitudinal fascicules and abducens nuclei. Oral antiplatelet was prescribed and lifestyle changes recommended to help prevent recurrence. Due to the fact that BHS is rarely seen in clinical settings, most frontline physicians are not familiar with it. Severe BHS could present with brainstem and cerebellar symptoms and may sometimes be misinterpreted as Ménière's disease. It is even more difficult to distinguish BHS from benign paroxysmal positional vertigo in the case of comorbidity.

References


DeKleyn A, Versteegh C: Uber verschiedene formen von nemieres syndrom. Deutsche Ztschr Nervenh 1933; 132: 157-89. [In German].
Zaidi, H. A.,Albuquerque, F. C.,Chowdhry, S. A.,Zabramski, J. M.,Ducruet, A. F.,Spetzler, R. F.(2014).Diagnosis and management of Bow Hunter's syndrome: 15-year experience at Barrow Neurological Institute.World Neurosurg.82,733-8.
陳建志、陳登郎(2010)。偽裝成美尼攸氏病之獵弓鄭之病例報告。慈濟醫學。22,219-24。
陳建志、楊菁華、陳登郎、林炯堃(2011)。良性陣發性姿態性眩暈症與獵弓症候群共同致病。台灣老誌。6,251-8。
Anene-Maidoh, T. I.,Vega, R. A.,Fautheree, G. L.,Reavey-Cantwell, J. F.(2013).An unusual case of pediatric bow hunter's stroke.Surg Neurol Int.4,148.

Read-around


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