Ariës Marcel J H, van Oostrom Joost C H, de Keyser Jacques
Department of Neurology, University Medical Centre Groningen, University of Groningen, The Netherlands.
J Stroke Cerebrovasc Dis. 2008 Jul-Aug;17(4):246-7. doi: 10.1016/j.jstrokecerebrovasdis.2008.02.010.
Headache with neurologic deficits and cerebrospinal fluid lymphocytosis is a benign condition with a transient ischemic attack-like presentation. We present a case of a 22-year-old man with episodes of right-sided weakness, global dysphasia, and right-sided homonymous hemianopsia associated with frequent vomiting. Systemic thrombolytic therapy was considered. A subsequent magnetic resonance image with diffusion-weighted images revealed normal findings. A diagnosis of headache with neurologic deficits and cerebrospinal fluid lymphocytosis was made based mainly on clinical symptoms and cerebrospinal fluid analysis. With the current pressure on "door-to-needle" time for thrombolysis, it is important to keep an open eye to stroke mimics and exclude them if possible. We, therefore, strongly advise considering noninvasive magnetic resonance diffusion-weighted imaging in patients with unusual presentations (e.g., the vomiting in our patient) before thrombolysis.
伴有神经功能缺损和脑脊液淋巴细胞增多的头痛是一种具有短暂性脑缺血发作样表现的良性疾病。我们报告一例22岁男性病例，其出现右侧肢体无力、完全性失语和右侧同向性偏盲发作，并伴有频繁呕吐。曾考虑进行全身溶栓治疗。随后的磁共振成像及弥散加权成像显示结果正常。主要基于临床症状和脑脊液分析，诊断为伴有神经功能缺损和脑脊液淋巴细胞增多的头痛。鉴于目前溶栓治疗“门到针”时间的压力，重要的是要密切关注疑似中风的情况并尽可能排除它们。因此，我们强烈建议在溶栓前，对表现异常（如我们病例中的呕吐症状）的患者考虑进行无创磁共振弥散加权成像检查。
