Late Onset Buerger's Disease with Multiple Cerebral Infarcts

Burger's disease是一種不常見的血管阻塞性疾病，一般常發生在45歲以下並有長期吸菸習慣的男性。主要發生的位置在四肢的中小型血管，腦血管的侵犯極為少見，過去只有兩例45歲以上伴隨腦血管侵犯的案例報告。我們的病例是第一例45歲以上，且同時即伴隨腦中風的Burger's disease案例。個案為57歲男性，出現突發性右側肢體麻木，除了過去42年每天吸菸一包之外，並無其他心血管疾病的危險因子。理學檢查發現左臉及右側肢體麻木，同時伴隨左側視野偏盲及眼球運動受損。腦部磁振造影發現，小腦、枕葉及左側視丘有新的血管梗塞；左手手指亦出現疼痛及雷諾氏現象(Raynaud's phenomenon)。血管攝影則呈現左側尺動脈及橈動脈狹窄，並在腕部出現側枝循環。血清學檢查排除自體免疫疾病的可能性。Burger's disease的主要治療方式為戒菸，如果能成功戒菸一般預後相當良好。本案例經過戒菸及藥物治療一週後，疼痛及發紺的情形改善。

關鍵字

Buerger氏症；腦中風；晚發性

並列摘要

The first case of late onset Buerger's Disease with synchronous cerebral involvement is reported. A 57-year-old male, who was a heavy smoker, presented with sudden onset right limb numbness. Physical examination showed cross-over numbness on the left side of his face and right side of his trunk, left homonymous hemianopsia and extra-ocular muscle limitation. The brain MRI showed multiple new infarcts in the cerebellum, occipital lobe and left thalamus. Cyanosis of the digits of the left hand was also discerned, with progression accompanied by pain and repeated episodes of biphasic color changes indicating Raynaud's phenomenon. The angiography showed stenosis at the left distal ulnar and radial arteries of the wrist, and collateral vessels from the anterior interosseous artery. Serological study showed no evidence of autoimmune disease. The patient was advised to stop smoking and medication was also given. His pain and cyanosis gradually improved within 1 week. The clinical course, imaging results and laboratory study of this unique case is demonstrated herein.

並列關鍵字

Buerger's disease ； cerebral infarcts ； late onset

國際替代計量

Late Onset Buerger's Disease with Multiple Cerebral Infarcts

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