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Artery Dissection and Headache
神經內科 林高章醫師奇美醫學中心
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Case 1• 45yrs, female, uterine myoma s/p in 90-2, at VGH-Taipei.
• Bokey during 90-92’s, for pregnancy used.
• Deny systemic disease-HTN, DM, etc.
• No family history, no migraine history.
C.C• Sudden onset of left hand grasping weakness on 98-6-27, clumsy
and sore.
• Slurred speech on 98-6-28, and visited Chi-Mei ER. No progressive weakness.
• Right temporal pulsatile headache on moving heavy things 1-day before stroke, mild intensity, duration for minutes, without further associated symptoms. (reminding recall).
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• 190/110, 88/min, no fever, supple neck.
• PE: NP (no murmur, no carotid bruits)
• NE (+): mp 3+/5, distal clumsy hand, slurred speech.
• Lab(+): CRP=18.5 (<3), Hb=10.7, LDL=149mg (T-211)
• Protein-C, S, anti-thrombin-III, thyroid: negative.
• Cardiac echo: normal chamber size (LVEF=59%), no vegetati
on.
• Carotid echo: mild atherotic change (0/.8/0.6-IMT), ICAs flo
wmeter (421/486 ml/m)
• CT and MRA: pending.
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CT (98-6-28)
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MRI (98-6-29)
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MRA f/u 1 m later (98-7-28)
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MRI 1 m later (98-7-28)
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MRI 1 m later (98-7-28)
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MRA f/u (99-2-8)
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MRA f/u (99-02-08)
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MRI f/u (99-02-08)