以急性週邊性眩暈為初始表徵之急性外延髓及小腦梗塞合併初血性轉換－病例報告

Acute Peripheral Vertigo as an Initial Presentation of Acute Lateral Medullary and Cerebellar Infarction with Hemorrhagic Transformation: A Case Report

10.6200/TCMJ.2014.11.1.11

陳建志(Jiann-Jy Chen)；鄒永恩(Yung-An Tsou)；蔡銘修(Ming-Hsui Tsai)；陳登郎(Dem-Lion Chen)

急性週邊性眩暈 ； 推頭測試 ； 外延髓梗塞 ； 小腦梗塞 ； 出血性轉換 ； acute peripheral vertigo ； head thrust test ； lateral medullary infarction ； cerebellar infarction ； hemorrhagic transformation

北市醫學雜誌

11卷1期（2014 / 03 / 30）

104 - 111

繁體中文

面對眩暈時要設法分辨是中樞性或是週邊性，從特殊的眼振型態、陽性推頭測試，以及神經學檢查無異常發現，可以推斷是否為週邊性眩暈。一90歲男性，因急性眩暈發作被送至本院急診，前庭功能測試顯示快速相向右之注視性眼振（符合Alexander氏法則），向左推頭測試呈現陽性，無聽覺及其他腦幹病症或徵候，腦部電腦斷層無異常發現，初步臆斷為左側前庭神經炎。然而，2日後的電腦斷層及磁振造影發現是左側外延髓及左側小腦的急性梗塞合併出血性轉化。3週後死於敗血性休克合併多重器官衰竭。前庭神經炎大多發生於成年人或中年人，若發生於老年人，加上合併高血壓、心房震顫、高膽固醇血症或糖尿病等腦梗塞之危險因子時，有可能是腦梗塞所致。

The first task of the examining physician is to determine if the vertigo is of central or peripheral origin. Acute peripheral vertigo can be confirmed based on the type of spontaneous nystagmus, the positive head-thrust test, and the absence of neurologic signs. A 90-year-old man presented to our emergency with acute vertigo. Vestibular function test demonstrated rightward gaze nystagmus (compatible with Alexander's law), left positive head thrust test, and the absence of auditory or brainstem symptoms or signs. Brain computed tomography did not demonstrate any remarkable finding. Therefore, left vestibular neuritis was impressed. However, two days later, brain computed tomography and magnetic resonance imaging demonstrated acute infarction of the left upper medulla and cerebellum with hemorrhagic transformation. He died of septic shock with multiple organ failure three weeks later. Vestibular neuritis mostly occurs in adults or middleagers. If vestibular neuritis occurs in an aged person with stroke risk factors of hypertension, atrial fibrillation, hypercholesterolemia or diabetic mellitus, brain infarction is possible.