合併單側搏動性耳鳴之原發性運動頭痛

Primary Exertional Headache with Unilateral Pulsatile Tinnitus

陳建志(Jiann-Jy Chen) ； 劉智仰(Chih-Yang Liu) ； 孫盛義(Sheng-Yih Sun) ； 陳登郎(Dem-Lion Chen)

《台灣耳鼻喉頭頸外科雜誌》 46卷1期 (2011/02) Pp. 39-43

https://doi.org/10.6286/2011.46.1.39

摘要

搏動性耳鳴需考慮腫瘤性或血管性病灶。原發性運動頭痛之病理機轉目前仍未知，國內文獻亦很有限。一32歲男性，因運動時出現左側搏動性耳鳴及運動後發作無預兆偏頭痛1個多月求診於本院，理學檢查、心電圖、前庭功能檢查、聽力檢查及血液學檢查均無異常發現，但頭部血管超音波顯示右側椎動脈血流量及管徑較左側小，血管磁振造影顯示前方威利氏環不完整、右側椎動脈發育不全、基底動脈彎曲及左側顱內椎動脈成角彎曲。於是，建議每日服用腦循環促進劑及indomethacin，並調整生活及運動習慣。1週後，所有病症均已緩解，而1個月後，病症均己消失。本個案運動時可能經由左側顱內椎動脈的成角彎曲造成左側搏動性耳鳴，運動後以一個不明的機轉引起無預兆偏頭痛，可能是後顱窩循環之血流不穩，引起頭暈、視力模糊或步態不穩等症狀，鑒於合併單側搏動性耳鳴之原發性運動頭痛實屬罕見，特提出報告與討論。

關鍵字

搏動性耳鳴 ； 椎動脈發育不全 ； 偏頭痛 ； 原發性運動頭痛 ； 頭暈

並列摘要

If the rate of pulsatile tinnitus (PT) is the same as heart beats, a neoplasm or vascular lesion should be impressed. Primary exertional headache (PEH) is yet of unknown etiology and limited in the Taiwan literature. A 32-year-old male presented with left exertional PT and post-exertional migraine without aura for over a month. Physical examination, electrocardiogram, vestibular function test, audiometry, and blood examinations showed normal, but neck duplex ultrasonography showed smaller caliber and less blood flow in the right vertebral artery (VA) than left. Magnetic resonance angiogram revealed defect of anterior circle of Willis, right VA hypoplasia, basilar artery tortuosity and left intracranial VA angulation. A brain circulatory promoter and indmethacin were recommended, and his living and exercise habits were modified, too. After one week, all symptoms subsided, and in the following one month, it was uneventful. Therefore, it is probable that the left intracranial VA angulation led to left PT when exercise, and an unknown mechanism led to migraine without aura after exercise; furthermore, unstable blood flow of posterior circulation led to dizziness, blurred vision or unstable gait. Because PEH with unilateral PT is a rare curiosity, we report the case herein.

並列關鍵字

pulsatile tinnitus ； vertebral artery hypoplasia ； migraine ； primary exertional headache ； dizziness