Biedroń Agnieszka, Steczkowska Małgorzata, Zajac Anna, Stolarska Urszula, Kroczka Sławomir
Katedra Neurologii Dzieci i Młodziezy, Uniwersytet Jagielloński Collegium Medicum, Kraków.
Przegl Lek. 2009;66(11):952-7.
Migraine with aura is characterized by reversible focal neurological symptoms preceding or accompanying headache. Visual aura is the most common type of aura and its patognomic symptoms are scintillating fortification migrating across the visual field or scintillating scotoma. However, the symptoms are not always so typical and clinical doubts are greater when negative symptoms (loss of vision, numbness or paresis) are present. Differential diagnosis of migraine with aura includes in the first place transient ischemic attack (TIA) as well as epilepsy. Diagnosis of migraine in the developmental age is more difficult and associated with unprecise description of the symptoms. Thorough history taking is crucial in migraine diagnosis and following management. Knowledge of migraine with aura symptoms, clinical differences associated with developmental age and features enabling differentiation with other disorders imitating migraine is very important.
Description of aura types and characteristics of migraine headache and their accompanying symptoms in children.
30 children were included, aged 8-17 years (mean 13,6 years), hospitalized at Department of Pediatric Neurology Chair of Pediatric and Adolescent Neurology, Jagiellonian University in 14 months of years 2008 and 2009. Clinical analysis was based on inquiry addressed to the patients and their parents.
Migraine with visual aura was established in 9 patients, with somatosensory aura in 4, visual and somatosensory in 5, visual and dysphasic in 1, visual, somatosensory and dysphasic in 5, somatosensory and dysphasic in 2 and basilar type migraine in 4 patients. Consequently, symptoms of visual aura were present in 20/30 patients, in 9 of them it was the only type of aura and in 11 coexisted with other aura types. In more than half cases it manifested as simple visual phenomenons (spots, dots, frills, lines). Blurred vision was found in 5 patients (bilateral in 3, unilateral in 3) and hemianopia in 2 (bilateral in aura was observed in 16/30 patients and only in 4 of them it occurred without other aura symptoms. Dysphasic aura accompanied other aura types in 8 cases. Basilar type migraine was established in 4 patients. Unilateral migrainous headache occurred in 20/30 patients. Pain intensity was defined as very severe, severe and moderate in the following 10, 12 and 8 patients. Pulsating quality of the pain was found in 15 cases. Aggravation of headache by movement was observed in 22/30 patients. Nausea was the most common accompanying symptom present in 20/30 patients. Vomiting, photophobia and phonophobia occurred in 15 patients each. Coexistence of nausea and/or vomiting, photo- and phonophobia was reported in 12 cases. Vertigo and balance disturbances were frequently found additional symptoms and occurred in 11 and 2 patients and in 6 coexisted together. Positive family history of migraine was reported in 18/30 patients.
伴先兆偏头痛的特征是在头痛之前或伴随头痛出现可逆性局灶性神经症状。视觉先兆是最常见的先兆类型，其典型症状是闪烁的堡垒样图形在视野中移动或闪烁性暗点。然而，症状并不总是如此典型，当出现阴性症状（视力丧失、麻木或轻瘫）时，临床疑虑更大。伴先兆偏头痛的鉴别诊断首先包括短暂性脑缺血发作（TIA）以及癫痫。发育年龄阶段偏头痛的诊断更为困难，且与症状描述不精确有关。详尽的病史采集在偏头痛的诊断及后续管理中至关重要。了解伴先兆偏头痛的症状、与发育年龄相关的临床差异以及有助于与其他模仿偏头痛的疾病相鉴别的特征非常重要。
描述儿童偏头痛先兆类型、头痛特征及其伴随症状。
纳入30名年龄在8至17岁（平均13.6岁）的儿童，于2008年和2009年的14个月期间在雅盖隆大学儿科与青少年神经学系儿科神经学教研室住院。临床分析基于对患者及其父母的询问。
9例确诊为伴视觉先兆偏头痛，4例为伴躯体感觉先兆偏头痛，5例为视觉和躯体感觉先兆偏头痛，1例为视觉和言语困难先兆偏头痛，5例为视觉、躯体感觉和言语困难先兆偏头痛，2例为躯体感觉和言语困难先兆偏头痛，4例为基底型偏头痛。因此，20/30例患者出现视觉先兆症状，其中9例为唯一的先兆类型，11例与其他先兆类型共存。超过半数病例表现为简单的视觉现象（斑点、小点、条纹、线条）。5例患者出现视力模糊（3例双侧，2例单侧），2例出现偏盲（1例双侧偏盲）。16/30例患者观察到先兆中的双侧性，其中仅4例在无其他先兆症状的情况下出现。8例言语困难先兆与其他先兆类型共存。4例确诊为基底型偏头痛。20/30例患者出现单侧偏头痛性头痛。疼痛强度在以下10例、12例和8例患者中分别定义为非常严重、严重和中度。15例患者的疼痛具有搏动性。22/30例患者观察到运动可加重头痛。恶心是最常见的伴随症状，20/30例患者出现。呕吐、畏光和畏声各有15例患者出现。12例患者报告同时存在恶心和/或呕吐、畏光和畏声。眩晕和平衡障碍是常见的附加症状，分别有11例和2例患者出现，6例患者同时存在这两种症状。18/30例患者报告有偏头痛阳性家族史。
