Saxton E H, Miller T Q, Collins J D
Department of Neurology, UCLA School of Medicine, USA.
J Natl Med Assoc. 1999 Jun;91(6):333-41.
This article describes migraine without aura since childhood in a patient with bilateral cervical ribs. In addition to usual migraine triggers, symptoms were triggered by neck extension and by arm abduction and external rotation; paresthesias and pain preceded migraine triggered by arm and neck movement. Suspected thoracic outlet syndrome was confirmed by high-resolution bilateral magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) of the brachial plexus. An unsuspected aberrant right subclavian artery was compressed within the scalene triangle. The aberrant subclavian artery splayed apart the recurrent laryngeal and vagus nerves, displaced the esophagus anteriorly, and effaced the right stellate ganglia and the C8-T1 nerve roots. Scarring and fibrosis of the left scalene triangle resulted in acute angulation of the neurovascular bundle and diminished blood flow in the subclavian artery and vein. A branch of the left sympathetic ganglia was displaced as it joined the C8-T1 nerve roots. Left scalenectomy and rib resection confirmed the MRI and MRA findings; the scalene triangle contents were decompressed, and migraine symptoms subsequently resolved.
本文描述了一名患有双侧颈肋的患者自童年起的无先兆偏头痛。除了常见的偏头痛触发因素外，颈部伸展、手臂外展和外旋也会引发症状；手臂和颈部运动引发偏头痛之前会出现感觉异常和疼痛。通过对臂丛神经进行高分辨率双侧磁共振成像（MRI）和磁共振血管造影（MRA），证实了疑似胸廓出口综合征。一条未被怀疑的异常右锁骨下动脉在斜角肌三角内受到压迫。异常的锁骨下动脉使喉返神经和迷走神经分开，将食管向前推移，并使右星状神经节和C8-T1神经根消失。左侧斜角肌三角的瘢痕形成和纤维化导致神经血管束急性成角，锁骨下动脉和静脉血流减少。左交感神经节的一个分支在与C8-T1神经根相连时发生移位。左侧斜角肌切除术和肋骨切除术证实了MRI和MRA的结果；斜角肌三角内容物得到减压，偏头痛症状随后得到缓解。
