Newly Onset Hiccups with Vertigo as Initial Presentation of Left Vertebral Artery Dissection: A Case Report

以打嗝為初始表現之椎動脈剝離個案報告

邱詡懷(Hsu-Huai Chiu) ； 趙化全(Hua-Chuan Chao) ； 鍾佳青(Chia-Ching Chung) ； 劉家榛(Chia-Chen Liu)

《醫學與健康期刊》 11卷3期 (2022/11) Pp. 91-96

摘要

Intracranial vertebral artery (VA) dissection is a life-threatening condition with varies clinical manifestations including headache, vertigo, neck pain, ataxia, visual or sensory deficit. However, reports regarding initial presentation of solely having hiccups followed by vertigo in patients with VA dissection remain sparse. We report a 66-year-old man diagnosed with left medullary infarction secondary to left VA dissection, initially presented with newly onset hiccups and followed by vertigo, with rapid progression to the symptoms compatible with Wallenberg syndrome within twelve hours. The result of brain magnetic resonance image demonstrated intramural hematoma and dissecting stenosis of left VA. The followed up computed tomography angiography in 10 days after symptom onset showed tapering end of left VA with partial flow restoration. Our report highlights that newly onset hiccups could be the first isolated symptom of VA dissection and rapid progression of clinical symptoms should be considered.

關鍵字

Vertebral artery dissection ； Intracranial artery dissection ； Wallenberg syndrome ； Hiccups

並列摘要

顱內椎動脈剝離為一可能危及生命之疾病，其臨床表現十分多變。常見臨床症狀包含頭痛、暈眩、頸部疼痛、步態不穩、視覺或感覺缺損等等。本個案報告報導以打嗝及暈眩為初始表現之椎動脈剝離病例。病患為六十六歲男性診斷為左側椎動脈剝離合併左側延腦梗塞，初始以打嗝及暈眩表現，並惡化出現外側延髓症候群，後續磁振造影及血管攝影均證實左側椎動脈剝離之影像。本個案報告強調單純打嗝及暈眩可以為椎動脈剝離之唯一初始症狀。

並列關鍵字

椎動脈剝離 ； 顱內動脈剝離 ； 外側延髓症候群 ； 打嗝

參考文獻

Kim BM, Kim SH, Kim DI, et al.: Outcomes and prognostic factors of intracranial unruptured vertebrobasilar artery dissection. Neurology 2011;76:1735-41.

Gottesman RF, Sharma P, Robinson KA, et al.: Clinical characteristics of symptomatic vertebral artery dissection: a systematic review. Neurologist 2012;18:245-54

Hosoya T, Watanabe N, Yamaguchi K, et al.: Intracranial vertebral artery dissection in Wallenberg syndrome. AJNR Am J Neuroradiol 1994;15:1161-5.

Matsukawa H, Shinoda M, Fujii M, Takahashi O, Uemura A, Niimi Y: Basilar extension and posterior inferior cerebellar artery involvement as risk factors for progression of the unruptured spontaneous intradural vertebral artery dissection. J Neurol Neurosurg Psychiatry 2014 85:1049-54.

Chen WL, Chern CH, Wu YL, Lee CH: Vertebral artery dissection and cerebellar infarction following chiropractic manipulation. Emerg Med J 2006;23:1.