以偏頭痛性眩暈為表徵之單側椎動脈畸形－病例報告

Unilateral Vertebral Artery Anomaly Masquerading as Migrainous Vertigo-Case Report

10.30145/STJHMNJ.200906.0007

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

椎動脈畸形 ； 偏頭痛性眩暈 ； 基底動脈偏倚 ； 後顱窩循環 ； vertebral artery anomaly ； migrainous vertigo ； basilar artery deviation ； posterior circulation

若瑟醫護雜誌

3卷1期（2009 / 06 / 01）

51 - 58

繁體中文

偏頭痛性眩暈與一般的週邊性或中樞性眩暈不同，偏頭痛性眩暈往往會合併偏頭痛。-40歲男性，反復陣發性頭痛及直立性頭暈發作已經10年，初步臆斷為典型預兆偏頭痛性頭痛與偏頭痛性眩暈，前庭功能測試、聽力檢查、眼振電圖、兩耳溫差測試及前庭誘發肌性電位等檢查顯示可能有兩側下前庭神經或前庭神經核的障礙，頸部血管超音波及腦部血管磁振造影證實是右側椎動脈畸形及基底動脈偏倚，引起後顱窩循環左右分離及血管阻力增加，在突然起身站立易發瞬間的後顱窩循環不穩，影響到兩側下前庭神經或前庭神經核，導致陣發性頭暈，本個案之陣發性直立性頭暈與其偏頭痛應無關聯，不應視為偏頭痛性眩暈，因此，治療不僅應當給予抗偏頭痛藥物治療，亦應當給予抗血小板劑以降低後顱窩循環之血管阻力；1個月後病症消夫，追蹤迄今已經4個月，情況依然穩定。由於單倒椎動脈直接匯入同側後下小腦動脈之畸型實屬罕見，特提出報告。

Migrainous vertigo (MV) is different from a common peripheral vertigo or central vertigo because MV always complicates with migraine. A 40-year-old male presented with recurrent episodes of headache and orthostatic dizziness (OD) for 10 years. Typical aura with migrainous headache has been diagnosed, and MV has been impressed. Vestibular function test, audiometry, electronystagmogram, caloric test, and vestibular evoked myogenic potential showed there were possible impairments of bilateral inferior vestibular nerves or vestibular nuclei. However, neck duplex scanning and magnetic resonance angiogram showed right vertebral artery anomaly and basilar artery deviation. It is possible that bilateral separation and increased vascular resistance of posterior circulation (PC) led to transient PC insufficiency when he got up abruptly; then, bilateral inferior vestibular nerves or vestibular nuclei were influenced, and episodic OD generated. His episodic OD was independent of migraine, and was not MV Therefore, not only anti-migraine drugs, but also anti-platelet was recommended to reduce the vascular resistance of PC. One month later, all symptoms subsided; and in the following four months, it was uneventful. The vascular anomaly of unilateral vertebral artery, directly pouring into ipsilateral posterior inferior cerebellar artery, is a rare curiosity. We herein report the case.