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一位年輕女性以意識改變及右側無力來表現Moyamoya disease
A Case of A Female Patient Presenting Conscious Change and Right-Side Weakness Because of Moyamoya Disease
摘要
腦中風常見於老年人，一般以單側肢體無力呈現，若發生腦中風年齡是在40歲以下，稱為年輕型中風（Young stroke），臨床上除中風治療外更需積極找出發病原因，毛毛樣血管疾病（Moyamoyadisease, MMD）為一種慢性進行性腦血管閉塞疾病，由於顱內大血管狹窄或閉塞，導致小血管代償性生長，血管異常雜亂增生，形成煙霧狀構造而稱﹝1﹞。事實上，Moyamoya disease疾病發展與動脈粥樣硬化動脈狹窄的診斷過程非常相似。其疾病最關鍵特徵在Willis環雙側血管的漸行性狹窄與閉塞，小血管會產生側枝循環，因此一開始沒有症狀，部分個案出現頭痛、肢體感覺異常或不自主運動等非特異症狀，當出現缺血性中風、暫時性腦缺血與腦出血及癲癇等症狀就醫時，才藉由血管攝影檢查來確診，本文探討一位35歲年輕女性，因突發性的右側無力與意識改變就醫，確診為Moyamoya disease合併左側額顳葉腦中風，亦發現個案有糖尿病之問題，確診後因家屬對手術的考量，僅進行內科治療及復建，個案右側肢體完全無力、感覺及認知行為功能異常情況下，日常生活須依賴他人的照護，自主性下降，身體功能的殘障，影響其生活品質，也成為家庭與社會嚴重負擔，雖在復健及藥物的治療下自我照顧能力改善，但仍為再度中風之高風險個案，也無法重回職場。藉此文分享臨床診斷年輕型中風患者時，應將此一疾病納入考量，期能供後續醫護人員及臨床個案參考此疾病之治療與照護。
並列摘要
Hemiplegia is a major symptom of cerebral vascular accidents (CVA) and CVA often occurs in elderly adults. Young stroke refers to CVA which happens under 40 years-old. Not only is the treatment for young stroke vital, but the etiology is also vital. Moyamoya disease in adults is rare. It is a progressive vascular disorder associated with stenosis of internal carotid artery and the Circle of Willis. Moyamoya disease is a chronic progressive cerebrovascular disease, characterized by stenosis or occlusion of the intracranial large blood vessels, compensatory growth of small blood vessels, and capillary abnormalities, which lead to formation of a smoke-like structure. The most critical feature of the disease is the progressive stenosis and occlusion of the bilateral vessels in the Circle of Willis. Small blood vessels produce collateral circulation, so there are no symptoms at first. Some cases have headaches, limb paresthesia or involuntary movement. This report describes a young women complaining of a sudden conscious change and right-sided hemiplegia. She was then diagnosed with moyamoya disease combined with a left fronto-temporal stroke. The patient experienced movement, sensation, and cognition impairment, so that she suffered from dependence in daily life, had poor quality of life and was a burden to her family. The case report can serve as a reference for care and treatment of patients with moyamoya disease.