Sakakibara Yohtaro, Taguchi Yoshio, Uchida Kazuyoshi
Division of Neurosurgery, Department of Neurosurgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki-shi, Kanagawa 216-8511, Japan.
No Shinkei Geka. 2010 Mar;38(3):287-91.
A 40-year-old man presented with progressive visual impairment accompanied by throbbing headache. First he had throbbing headache in the left temporal region. At the same time he noticed a blind spot in the upper right quadrant. This blind spot gradually became enlarged. Since the patient had throbbing headache accompanied by right homonymous hemianopsia, his illness was initially diagnosed as migraine. Sumatriptan was prescribed. However, thereafter his headache still continued. He described his seeing of some lights like neon signs. Magnetic resonance imaging revealed a typical feature of cavernous angioma (CA) at the left temporooccipital lobe and electroencephalogram showed frequent spike waves at the same region. Because of progressive deterioration of his condition despite the treatment with antiepileptics, left temporal craniotomy was performed. The CA was removed with a small amount of surrounding gliotic tissue using an intraoperative cortical EEG recording. Postoperatively, his visual symptoms and headache disappeared. Although migraine is one of the most frequently encountered symptoms in daily practice, differentiation of migraine from seizure - associated headache is extremely difficult, because both conditions may manifest similar features of visual impairment with throbbing headache. When clinicians see a patient presenting with throbbing headache accompanied by visual symptoms, CAs or other space occupying lesions, should be kept in mind of a differential diagnosis of migrainous attacks.
一名40岁男性患者出现进行性视力损害并伴有搏动性头痛。起初，他左侧颞部出现搏动性头痛。与此同时，他注意到右上象限有一个盲点。这个盲点逐渐扩大。由于患者出现搏动性头痛并伴有右侧同向性偏盲，其病情最初被诊断为偏头痛，并开具了舒马曲坦。然而，此后他的头痛仍持续。他描述自己看到一些类似霓虹灯的光。磁共振成像显示左颞枕叶有典型的海绵状血管瘤（CA）特征，脑电图显示同一区域频繁出现尖波。尽管使用抗癫痫药物治疗，但患者病情仍逐渐恶化，因此进行了左颞开颅手术。术中使用皮质脑电图记录，将CA及其少量周围胶质增生组织一并切除。术后，他的视觉症状和头痛消失。尽管偏头痛是日常实践中最常见的症状之一，但偏头痛与癫痫相关性头痛的鉴别极为困难，因为这两种情况都可能表现出类似的搏动性头痛伴视力损害特征。当临床医生遇到伴有视觉症状的搏动性头痛患者时，应考虑到CA或其他占位性病变，以鉴别偏头痛发作。
