美尼攸氏病或突發性耳聾可能是偏頭痛之前驅症狀－病例報告

Meniere's Disease or Sudden Deafness as a Probable Premonitory Symptom of Migraine-Case Report

10.30145/STJHMNJ.201006.0006

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

突發性耳聾 ； 美尼攸氏病 ； 偏頭痛性眩暈 ； 前驅症狀 ； sudden deafness ； Ménière's disease ； migrainous vertigo ； premonitory symptom

若瑟醫護雜誌

4卷1期（2010 / 06 / 01）

58 - 64

繁體中文

美尼攸氏病、突發性耳聾與偏頭痛性眩暈三者有時會相當類似，鑑別診斷頗具挑戰。一39歲男性，近3年內反覆眩暈及右側耳鳴發作共計3次，應為右側美尼攸氏病，合併（口惡）心、嘔吐、畏聲及畏光，亦可能是偏頭痛前驅症狀之偏頭痛性眩暈。由於第3次病症發作後，右側耳鳴持續1週求診於本院，理學檢查無異常發現，眼振電圖、兩耳溫差測試、前庭誘發肌性電位檢查及血液學檢查均為正常，血管磁振造影呈現基底動脈彎曲及後方威利氏環不完整，純音聽力檢查顯示右側250~4，000Hz之平均聽閾為66dBHL，應為突發性耳聾。經保守治療2個月後，右側耳鳴消失，純音聽力檢查顯示右側平均聽閾恢復為23dBHL，追蹤迄今已半年，情況依然穩定，爾後尚須長期追蹤是否會演變成偏頭痛。

Ménière's disease, sudden deafness and migrainous vertigo are occasional similar. It is a challenge to differentiate them. A 39-year-old male has been bothered with episodic vertigo and right tinnitus for three times in recent three years. Not only right Ménière's disease, but also migrainous vertigo of migrainous premonitory symptom was impressed because nausea, vomiting, phonophobia and photophobia were noted. After the 3rd attack, he was bothered with right tinnitus for one week. Physical examination was normal. Electronystagmogram, caloric test, vestibular-evoked myogenic potential, and blood exams were normal. Magnetic resonance angiogram revealed basilar artery tortuosity and defect of posterior circle of Willis. Pure tone audiometry showed right-ear average threshold (250~4,000Hz) was 66dBHL. Therefore, sudden deafness was diagnosed, and conservative treatment was recommended. Two months later, right tinnitus subsided. Pure tone audiometry showed right-ear average threshold was 23dBHL. In the following half a year, it was uneventful. He is followed if migraine will develop in the future.