偏头痛性眩晕与基底型偏头痛(附9例临床分析)

目的分析9例偏头痛伴眩晕/头晕患者的临床及实验室检查结果,探讨头痛与眩晕/头晕的关系,以利正确诊治。方法作者医院收治的偏头痛伴眩晕/头晕患者9例,对所有患者均详细收集病史,并进行神经系统查体以及前庭功能、听力检查和头颅CT/MRI等实验室检查,以除外中枢性和耳源性眩晕。结果 9例偏头痛伴眩晕/头晕患者中,基底型偏头痛2例,无先兆偏头痛3例,偏头痛性眩晕(migrainous vertigo,MV)6例(其中2例为无先兆偏头痛发作数年后和50岁后转变为MV)。本组6例MV患者中,眩晕/头晕在头痛发作前数秒钟～1h内发生3例,在头痛发作后发生1例,与头痛同时发生1例,另1例偏头痛患者其头痛与眩晕从未同时发作过,为偏头痛等位征。结论 MV是不同于基底型偏头痛的头痛伴眩晕综合征,二者易与梅尼埃病、良性复发性位置性眩晕、后循环缺血(posterior circulation ischemia,PCI)等周围性和中枢性眩晕混淆或并存,临床应注意鉴别。

Migrainous vertigo and basilar migraine(Analyze the clinical symptoms of 9 migraine patients with vertigo)

Objective By analysing the results of clinical and laboratory examinations in 9 migraine patients with vertigo or dizziness,we aimed to recognize the relationship between migraine and vertigo,and to improve the diagnosis and treatments of the patients.Methods Nine migraine patients with vertigo/dizziness were selected from our hospital.Besides the detailed questionnaire on the medical history,clinical and laboratory examinations,including neurological examination,vestibule functioning,hearing tests and head CT/MRI,were adopted in each patient,so as to exclude the cases caused by central and vestibule related vertigo.Results Among the 9 migraine patients with vertigo /dizziness,there were 2 cases of basilar migraine,3 cases of migraine without aura,and 6 cases of migrainous vertigo(MV,in which 2 migraine patients changed to MV).In the 6 MV patients,vertigo or dizziness occurred several seconds to one hour prior to the headache in 3 cases,post headache in 1 case and simultaneously with headache in 1 case.There was one migraine case,whose headache never occurred together with vertigo,called migraine equivalent.Conclusions MV is a special type of migraine syndrome associated with vertigo or dizziness due to basilar migraine.The diagnosis needs to be distinguished clearly from Meniere’s disease,benign paroxysmal positional vertigo,posterior circulation ischemia(PCI),etc.