Artery Dissection and Headache

神經內科　林高章醫師奇美醫學中心

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).

• 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.

CT (98-6-28)

MRI (98-6-29)

MRA f/u 1 m later (98-7-28)

MRI 1 m later (98-7-28)

MRI 1 m later (98-7-28)

MRA f/u (99-2-8)

MRA f/u (99-02-08)

MRI f/u (99-02-08)