鎖骨下竊血症候群－病例報告

頭暈是基層醫療門診中經常遇見的主訴之一，對臨床醫師也是極富挑戰性的問題。鑑別診斷病因繁雜，詳細的病史是評估病人的道要工作，除了詢問病人是否有眩暈(vertigo)、不平衡感(disequilibrium/ imbalance)、頭部輕飄感(light-headedness)、眼部頭暈(ocular dizziness)等，也請病人詳述頭暈的發生與持續時間(如突發的頭暈，持續幾秒/分鐘，甚至幾天)，以及伴隨的相關症狀(如鼻塞、耳鳴、聽力喪失、與頭部或上臂活動有關、或其他神經症狀)，再參考病人的年齡、過去病史、工作、身心壓力，配合正確的理學與實驗室檢查，而有不同的鑑別診斷。本病例是一40歲男性病患因長期間歇性頭暈，理學檢查發現兩側手臂血壓又橈動脈脈博有明顯差異，經安排頸部血管超音波檢查，診斷為鎖骨下竊血症候群(subclavian steal syndrome)，並給予適當的治療。本文的目的是希望藉此病例以及文獻的回顧，提醒基層醫師在繁忙的醫療中，對眾多以頭暈為主訴的病患，要記得可以靠兩側上臂明顯的血壓差來進一步正確的診斷鎖骨下竊血症候群。

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並列摘要

Dizziness is one of the most common chief complaints observed in general practice, and it is also a challenging problem to the doctors. A complete history is the first task of evaluating the patients. Dizziness can be described as vertigo, imbalance, light-headedness and ocular dizziness. The onset and duration (such as sudden onset, duration for seconds or minutes, even days) of dizziness should also be mentioned. The associated symptoms (such as nasal stiffness, tinnitus, hearing loss, etc) are important clues to the doctors. A reference to patient’s age , past history, job , and psychosocial pressure complementing correct physical examination and laboratory studies will result in differential diagnoses. A case of the study is about a 40-year-old male patient who had suffered from intermittent dizziness over a long period of time. The decreased blood pressure and diminished radial pulse on the left arm were noted in the physical examination. Carotid Duplex-sonography showed subclavian steal syndrome. With this case study and journal reviews, the purpose of this article is to remind doctors that the significant difference of blood pressure and radial pulse between two arms can be a screening measure for subclavian steal syndrome among patients with dizziness.