不尋常的鎖骨下竊血症候群表現－一個病例報告

Unusual Presentation of Subclavian Steal Syndrome: A Case Report

林俊豪(Chun-Hao Lin) ； 鍾嫈嫈(Jin-Jin Tjung) ； 傅維仁(Helen L. Po) ； 林雅如(Ya-Ju Lin) ； 王淑芬(Shu-Fen Wang)

《臺灣家庭醫學研究》 4卷2期 (2006/04) Pp. 78-83

https://doi.org/10.29475/TFMR.200604.0003

摘要

鎖骨下竊血現象是向於鎖骨下動脈或無名動脈近端阻塞，引起同側脊堆動脈血液逆流所導致。這種現象在年老且患有廣泛性動脈粥狀硬化的病患身上並不少見。他們大多都是沒有症狀的，而其他有症狀的病人可能會有手臂的疼痛、問歇性的麻木無力或是一些非特異的頭暈等等，如果伴隨其他的血管病灶，甚至於會有大腦半球暫時性腦缺血發作或中風。
在此我們描述一個具有不尋常臨床症狀的鎖骨下竊血症候群病例。一位八十一歲的婦人因跌倒之後左肩疼痛加劇而被診斷為頸椎關節黏連或肌筋膜疼痛症候群。患者在左肩熱敷復暈厥，經病史詢問，病人抱怨有左手臂間歇性的麻木及疼痛大約一年之久。顱外都卜勒超音波影像及導管血管攝影顯示有嚴重的左側鎖骨下動脈近端及兩側的內頸動脈狹窄，並有左側脊椎動脈的血流逆流現象。本文就疾病的診斷、側枝循環的模式與臨床表現的關連一併做深入探討。

並列摘要

The subclavian steal phenomenon results from occlusion of the proximal subclavian or innominate artery that causes reversal of blood flow in the ipsilateral vertebral artery. It is not uncommon in older patients with widespread atherosclerosis. Most of them had no symptoms and the others may have symptoms such as pain, numbness, intermittent claudication in the arm, non-specific dizziness, or even hemispheric transient ischemic attacks if accompanied with other vascular lesions.
Here we present a case of subclavian steal syndrome with unusual clinical mainfestation. This is an 81-year-old female with the complaints of numbness and pain over left arm off and on for about one year and suffered from syncope after heat packing on her left shoulder. Duplex sonography of extracranial vessels and catheter angiography confirmed the diagnosis of severe stenosis of left subclavian artery with complete steal phenomenon accompanying with severe stenosis of bilateral internal carotid artery. The diagnosis, the relationship between the pattern of collateral flows and clinical presentations were discussed.

並列關鍵字

subclavian steal syndrome ； syncope ； cervical spondylosis ； myofascial pain syndrome