Hattori Manabu, Uematsu Norihiko, Nakazawa Hideka, Matsukawa Noriyuki, Yamawaki Takemori, Ojika Kosei
Department of Neurology and Neuroscience, Nagoya City University Graduate School of Medical Sciences.
Rinsho Shinkeigaku. 2006 Sep;46(9):655-7.
A 30-year-old man presented with a 10-year history of recurrent, stereotypic episodes of incapacitating nausea and vomiting. Initially, he had been diagnosed as having superior mesenteric artery syndrome, and had undergone abdominal surgery at age 20. The patient was in good health between episodes. During each episode, oral intake was impossible and total parenteral nutrition and sedation were necessary. Conventional antiemetics such as metoclopramide were not effective, and the 5-HT3 antagonist ondansetron hydrochloride was only partially effective. Investigations into gastrointestinal, hormonal, and metabolic function were unremarkable, as was psychiatric evaluation. Diagnosing this to be an adult case of cyclic vomiting syndrome, we administered amitriptyline hydrochloride; a prophylactic agent for migraine. This resulted in rapid resolution of the episodes, which have not recurred over several years' follow up. Recently, cyclic vomiting syndrome has been considered a subtype of migraine. In the present case, effectiveness of the tricyclic antidepressant amitriptyline hydrochloride indicated that migraine and cyclic vomiting syndrome have a common pathology. Clinicians should be aware that cyclic vomiting syndrome can affect adults as well as children, and that treatment for migraine may be effective.
一名30岁男性，有10年反复发作的刻板性致残性恶心和呕吐病史。最初，他被诊断为肠系膜上动脉综合征，并在20岁时接受了腹部手术。发作间期患者健康状况良好。每次发作时，无法经口摄入食物，需要全胃肠外营养和镇静治疗。常规止吐药如甲氧氯普胺无效，5-HT3拮抗剂盐酸昂丹司琼仅部分有效。胃肠道、激素和代谢功能检查均无异常，精神科评估也无异常。诊断为成人周期性呕吐综合征后，我们给予了盐酸阿米替林，一种偏头痛预防性药物。这使发作迅速缓解，在数年的随访中未再复发。最近，周期性呕吐综合征被认为是偏头痛的一种亚型。在本病例中，三环类抗抑郁药盐酸阿米替林的有效性表明偏头痛和周期性呕吐综合征有共同的病理机制。临床医生应意识到周期性呕吐综合征可影响成人和儿童，且偏头痛的治疗可能有效。
