良性陣發性姿態性眩暈症與典型預兆非偏頭痛性頭痛

Benign Paroxysmal Positional Vertigo and Typical Aura with Non-migrainous Headache

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

《童綜合醫學雜誌》 4卷1期 (2010/06) Pp. 42-48

摘要

在缺乏明確的偏頭痛病史的情況下，要辨認偏頭痛性眩暈或其他週邊性眩暈其實並不容易，端賴詳盡的病史分析與理學檢查。一位50歲女性，因反覆姿態變換性眩暈後頭痛及左手感覺異常3日求診於本科，眼振電圖與前庭誘發肌性電位檢查顯示波形異常，合併血管造影之磁振造影顯示巨大小腦延髓池及後方威利氏環變異。鑒於相同病症在10年前曾連續發作過2~3個月，在去年也曾連續發作過1個月，可能是偏頭痛性眩暈。經抗偏頭痛藥物及抗眩暈藥物治療後，症狀減輕，可是，爾後Dix-Hallpike測試證實是良性陣發性姿態性眩暈症，並以Epley氏耳石復位術治癒頭暈，而先前的眩暈亦可能僅是週邊性眩暈。因此，本個案可能的診斷為典型預兆非偏頭痛性頭痛與良性陣發性姿態性眩暈症，或良性陣發性姿態性眩暈症後引發典型預兆非偏頭痛性頭痛。

關鍵字

眩暈 ； 頭痛 ； 良性陣發性姿態性眩暈症 ； 典型預兆非偏頭痛性頭痛

並列摘要

Lacking in past history of migraine, it is difficult to differentiate migrainous vertigo (MV) or other peripheral vertigo. Thus, a complete history reviewing and physical examination are necessary. A 50-year-old woman presented with headache and left hand paresthesia after positioning vertigo for three days. The electronystagmogram and vestibular evoked myogenic potential test showed abnormal waves. The magnetic resonance image/angiogram revealed a mega cerebellomedullary cisterna and a variant of the posterior circle of Willis. She has been bothered with the same course of disease for 2~3 months 10 years ago, and for a month last year, so the vertigo was probable MV. After she received anti-migraine and anti-vertigo therapies, the symptom relieved. However, benign paroxysmal positional vertigo (BPPV) has been proven by Dix-Hallpike test and then was cured by Epley's canalith repositioning procedure, so the previous vertigo was probably peripheral vertigo. Taken together, a typical aura with nonmigrainous headache and BPPV, or BPPV followed by typical aura with nonmigrainous headache should be the reasonable diagnosis for this patient.

並列關鍵字

vertigo ； headache ； benign paroxysmal positional vertigo ； typical aura with nonmigrainous headache