CADASIL（遺傳性腦血管病變）針刺治療病例報告

62歲女性複視近一年，過去病史：類風濕性關節炎及乾燥症十多年，平日有口乾眼乾症狀。數年前常左半側不適，如左後頭痛、左耳、足大趾等不適，自西元2018年，抬頭及眼球轉動間偶有殘影（3－5次／月），病患以為是眼乾勞累造成。西元2019年2月27日睡前劇烈暈眩，隔日晨起突發性複視，看距兩公尺以上的東西有重影，當天至耳鼻喉診所就診，又至本院眼科就診後皆改善不多。後輾轉於3月7日求診本院神經內科，MRI（Magnetic Resonance Imaging）影像：缺血性腦中風，主治醫師懷疑罹患CADASIL（Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy）（體顯性腦動脈血管病變合併皮質下腦梗塞及腦白質病變）。經本院神內醫師轉診至中醫部，於3月18日中醫初診針刺治療。當時看距兩公尺以上的東西有重影，經一個多月針刺治療，複視狀況漸減，除左轉頭看時複視明顯外，看距兩公尺以上的東西有重影的現象已較無，其餘發生在複視前的症狀，如：眼乾、口乾；及在複視後的症狀，如耳鳴、暈眩，在持續針刺治療中，漸獲一定程度改善。進步速度與程度遠超過西醫預期，一年後追蹤腦部MRI均無惡化現象，這也說明針刺治療確可幫助罕見的腦血管病變患者降少血管發炎病變，值得推廣給更多患者與西醫同道。

關鍵字

複視；遺傳性腦中風； CADASIL（Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy）；針刺治療

並列摘要

A 62-year-old female with medical history of rheumatoid arthritis and Sjögren's syndrome has had dry mouth and dry eyes since more than ten years ago with left side discomfort including left occipital headache, left ear discomfort and big toe pain in recent years. Since 2018, she has suffered from occasional afterimages (3-5 times/month) while rising head and moving eyes. On February 27, 2019, an attack of severe dizziness suddenly onset. Subsequent diplopia occurred in the next morning with progressed afterimages whenever sighting distance is over two meters. As a result, she visited local otolaryngology clinic and the ophthalmology department of our hospital but still in vain. On March 7, 2019, she visited our neurology department and the Brain MRI showed cerebral ischemic stroke with the attempted diagnosis of CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy). Thus, she was referred to our Department of Chinese Medicine for acupuncture therapy. On March 18, 2019, she had a double vision whenever sighting distance is over two meters. After one month of acupuncture treatment, the diplopia gradually improved and only happened when turning head to the left side. Since then, she has no longer had diplopia while seeing more than two meters. Besides, accompanied symptoms such as dry eye, dry mouth, tinnitus and dizziness also improved after acupuncture treatment. Acupuncture indeed help the patients with CADASIL by reducing the vascular inflammation. Because of the significant efficacy of the CADASIL case, we would love to share the case report to all health practitioners.

並列關鍵字

Diplopia ； Hereditary Stroke ； CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy) ； Acupuncture

參考文獻

李昌狄、徐培珊、陳建霖、黃建榮、游明謙（2018）：複視－神經急症之鑑別診斷思維與病例分享。[The Differential Diagnosis for Diplopia to Identify/Exclude Possible Emergency Neurological Diseases: Demonstrations from Two Clinical Cases]。中醫藥研究論叢 21(2)：151-168。doi:10.6516/tjtcm.201809_21(2).0014

Liao, Y.-C., Hsiao, C.-T., Fuh, J.-L., Chern, C.-M., Lee, W.-J., Guo, Y.-C., ...Lee, Y.-C. (2015). Characterization of CADASIL among the Han Chinese in Taiwan: Distinct Genotypic and Phenotypic Profiles. PLOS ONE, 10(8), e0136501. doi:10.1371/journal.pone.0136501

Shih, C. C., Liao, C. C., Sun, M. F., Su, Y. C., Wen, C. P., Morisky, D. E., ...Lin, J. G. (2015). A Retrospective Cohort Study Comparing Stroke Recurrence Rate in Ischemic Stroke Patients With and Without Acupuncture Treatment. Medicine (Baltimore), 94(39), e1572. doi:10.1097/md.0000000000001572

Martin Dichgans, M. (2020). CADASIL.UpToDate.Retrieved 30th Oct, 2020 from https://www.uptodate.com/contents/cerebral-autosomal-dominantarteriopathy-with-subcortical-infarcts-andleukoencephalopathy-cadasil

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CADASIL（遺傳性腦血管病變）針刺治療病例報告

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