可能基底型偏頭痛與意外發現之鼻及鼻竇炎

Basilar-type migraine (BTM) is frequently associated with relapses of vertigo, headache and gait incoordination. A forty-seven-year-old man visited our clinic complaining of morning vertigo and gait incoordination followed by ten days of daylong headaches, dizziness, and gait tilt. He was suspected of having migrainous vertigo, for which he was prescribed ergotamine and an anti-vertigo. One and a half months later, he returned to our clinic because he said there was no improvement in his condition. A physical examination showed no abnormality. A vestibular function test showed abnormality. Electrocardiogram, electroencephalogram, and blood examination were normal. Duplex ultrasonogram of neck showed that the right vertebral artery was smaller and had less blood flow than the left one. Magnetic resonance angiogram showed defect of posterior circle of Willis, vascular variants of posterior circulation, and rhinosinusitis (RS). He was prescribed anti-anxiety medication, antiplatelet, brain circulatory promoter, and corticosteroid nasal spray. Three weeks later his symptoms were resolved. In addition, a sinus X-ray showed normal. Therefore, he was diagnosed as having probable BTM. Because we did not know the patient's past rhinological history, we could not confirm that his headache was RS-related. 反覆發作的眩暈、頭痛及步態失調需考慮基底型偏頭痛。一名47歲男性，因每日晨間眩暈及步態失調發作，接著持續整日的頭痛、頭暈及步態偏倚10日後，求診於本院，初步臆斷為偏頭痛性眩暈，但以麥角鹼及抗眩暈藥治療1個半月後無效，轉介于作者。理學檢查無異常發現，但前庭功能測試呈現異常，心電圖、腦波圖及血液學檢查均無異常發現，頸部血管超音波顯示右側椎動脈管徑及血流過小，血管磁振造影顯示後方威利氏環不完整、後顱窩循環血管變異，併有鼻及鼻竇炎，最後以抗焦慮劑、抗血小板劑、腦循環促進劑及類固醇鼻噴劑治療3週後痊癒，鼻竇X光攝片追蹤顯示正常。本個案診斷為「可能基底型偏頭痛」，由於鼻科病史未明確，尚無法確認頭痛是否歸因於鼻及鼻竇炎。