合併後顱窩循環血管變異之慢性緊縮型頭痛及良性陣發性姿態性眩暈症

Chronic Tension-type Headache and Benign Paroxysmal Positional Vertigo Complicated Variants of Posterior Circulation

陳建志(Jiann-Jy Chen) ； 陳登郎(Dem-Lion Chen) ； 楊菁華(Chin-Hua Yang)

《北市醫學雜誌》 7卷3期 (2010/09) Pp. 265-272

https://doi.org/10.6200/TCMJ.2010.7.3.07

摘要

一61歲女性，因慢性每日頭痛半年及反覆姿態性眩暈1個月求診於本院，診斷為慢性緊縮型頭痛及良性陣發性姿態性眩暈症。可是，血液學檢查顯示為高血脂症，換氣過度測試可以引發類似的頭痛及頭暈，前庭誘發肌性電位檢查呈現左側P13波潛值延遲，血管磁振造影顯示後顱窩循環之血管變異，包括後方威利氏環變異、基底動脈分支變異、右側椎動脈發育不全及路徑異常。經Epley氏耳石復位術治癒其眩暈後，接著控制血脂與服用抗血栓療法。爾後1個月，不僅血脂下降，頭痛也自動消失，全程並未給予非類固醇類抗消炎藥物或三環抗鬱劑。追蹤迄今已1年5個月，情況依然穩定。慢性緊縮型頭痛確切的發病機轉目前仍不明，本個案究竟是自動痊癒？還是因降血脂及抗血栓療法而治癒？其慢性緊縮型頭痛是否與後顱窩循環變異有關？期待能引起更多研究與討論。

關鍵字

慢性緊縮型頭痛 ； 良性陣發性姿態性眩暈 ； 後顱窩循環 ； 高血脂症

並列摘要

A 61-year-old woman presented having had chronic daily headache for half a year and positional vertigo for one month. She was diagnosed with chronic tension-type headache and benign paroxysmal positional vertigo. However, her blood tests showed hyperlipidemia and a hyperventilation test was able to induce the same type of headache. Furthermore, a vestibular evoked myogenic potential assessment showed a bilaterally delayed latency of the left P13. Finally, a magnetic resonance angiogram showed the presence of several vascular variants of the posterior circulation, including a variation of the posterior circle of Willis, deficient branches of the basilar artery, and hypoplasia with route anomaly of the right vertebral artery. After an Epley's canalith repositioning procedure had cured the vertigo, she received blood lipid control and anti-thrombotic therapy; however she did not receive any non-steroid anti-inflammatory drugs or tri-cyclic anti-depressants. Over the following one month, the blood lipid level decreased and the headaches remitted. The following one and five months were also uneventful. Chronic tension-type headaches are as yet of unknown etiology. For this reason it is important that the patient should heal him/herself. In this case, she was cured by blood lipid control and anti-thrombotic therapy and there is also the possibility that the chronic tensiontype headache was related to the presence of the vascular variants of posterior circulation.

並列關鍵字

chronic tension-type headache ； benign paroxysmal positional vertigo ； posterior circulation ； hyperlipidemia