Brian M Grosberg, Deborah I Friedman, Matthew S Robbins, Allison M S Verhaak
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引用次数: 0
摘要
目的：报告一例既往有发作性偏头痛伴视觉先兆的患者，其持续性先兆症状在接受双丙戊酸钠治疗后才有所改善：背景：视觉先兆曾被认为是偏头痛的高度特异性症状，但也与三叉神经自律性头痛（包括头痛性眩晕）有关。在以往关于HC和典型视觉先兆发作的描述中，先兆仅在严重头痛加重时出现，并且与疼痛一样，在服用吲哚美辛后缓解：方法：病例报告和文献综述：结果：一名 54 岁的男性患者曾有发作性偏头痛伴视觉先兆的病史，报告说他逐渐出现了持续 15 个月的持续性偏头痛伴视觉先兆。一般体检和神经系统检查均正常，包括影像学检查。HC 的头痛对吲哚美辛有反应，而视觉先兆则很顽固，只有在口服双丙戊酸钠治疗后才有所改善：我们假设偏头痛和 HC 可能有共同的病理生理学。然而，尽管使用治疗剂量的吲哚美辛消除了疼痛和自律神经特征，但视觉先兆仍持续存在，随后使用双丙戊酸钠成功治疗了先兆，这表明先兆头痛和高频头痛产生于不同的、可分离的机制。
Pharmacological Dissociation in Hemicrania Continua With Persistent Visual Aura Evolved From Episodic Migraine: A Case Report.
Objective: To report a case of hemicrania continua (HC) and persistent visual aura without infarction in a patient with previous episodic migraine with visual aura, whose persistent aura symptoms improved only after treatment with divalproex sodium.
Background: Once regarded as highly specific for migraine, visual aura has been associated with trigeminal autonomic cephalalgias, including HC. In previous descriptions of HC and episodes of typical visual aura, the aura occurred exclusively with severe headache exacerbations and, like the pain, resolved with indomethacin.
Methods: Case report and literature review.
Results: A 54-year-old man with a history of episodic migraine with visual aura reported a gradual onset of HC with persistent visual aura of 15 months duration. General medical and neurological examinations were normal, including imaging studies. HC's headache responded to indomethacin, while the visual aura was recalcitrant, only improving with oral divalproex sodium treatment.
Conclusion: As our patient experienced HC, which evolved from episodic migraine, we hypothesize that migraine and HC may share a common pathophysiology. However, the persistence of the visual aura, despite the abolition of pain and autonomic features with a therapeutic dose of indomethacin, and the subsequent successful treatment of the aura with divalproex sodium, suggest that aura and HC headache arise from distinct and dissociable mechanisms.
期刊介绍：
The Neurologist publishes articles on topics of current interest to physicians treating patients with neurological diseases. The core of the journal is review articles focusing on clinically relevant issues. The journal also publishes case reports or case series which review the literature and put observations in perspective, as well as letters to the editor. Special features include the popular "10 Most Commonly Asked Questions" and the "Patient and Family Fact Sheet," a handy tear-out page that can be copied to hand out to patients and their caregivers.
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