Doi Hikaru, Tateishi Takahisa, Isobe Noriko, Yamasaki Ryo, Ohyagi Yasumasa, Kira Jun-ichi
Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University.
Rinsho Shinkeigaku. 2010 May;50(5):332-4. doi: 10.5692/clinicalneurol.50.332.
A 39-year-old woman suddenly developed numbness of the left arm following mild weakness of the left upper and lower extremities, blindness in the left visual field, and difficulty finding words. Her symptoms lasted for two hours with no deficit remaining. Six months after the first episode, the first of several more occurred. Two of the episodes were followed by nausea and a non-pulsative headache around the left temporo-parietal regions and the orbit. She had also been suffering recurrent skin eruptions for the previous two years. There was no family history of migraine. Her neurological symptoms fulfilled the criteria of sporadic hemiplegic migraine (SHM). Biopsy of skin eruption revealed lymphocytic infiltration and liquefied degeneration of basal lamina. These findings were compatible with systemic lupus erythematosus (SLE). There were no lesions evident on brain MR. We diagnosed SLE and after administration of aspirin (100 mg/day) and lomerizine hydrochloride (10 mg/day), her neurological symptom completely disappeared. SHM-like headache in patients with SLE is extremely rare. Although an autoimmune or thrombotic mechanism has been suggested for neurological symptoms in SLE, further studies are needed to elucidate the mechanism. We propose that SLE should be considered as one of the differential diagnoses of SHM.
一名39岁女性在左上肢和下肢轻度无力、左侧视野失明及找词困难后突然出现左臂麻木。她的症状持续了两小时，之后未遗留任何功能缺损。首次发作6个月后，又出现了几次发作，其中两次发作后伴有恶心以及左侧颞顶区和眼眶周围的非搏动性头痛。在之前的两年里，她还一直患有复发性皮疹。她没有偏头痛家族史。她的神经系统症状符合散发性偏瘫性偏头痛（SHM）的标准。皮疹活检显示淋巴细胞浸润和基底膜液化变性。这些发现符合系统性红斑狼疮（SLE）。脑部磁共振成像（MR）未发现明显病变。我们诊断为SLE，在给予阿司匹林（100毫克/天）和盐酸洛美利嗪（10毫克/天）后，她的神经系统症状完全消失。SLE患者出现类似SHM的头痛极为罕见。尽管有人提出自身免疫或血栓形成机制与SLE的神经系统症状有关，但仍需要进一步研究以阐明其机制。我们建议SLE应被视为SHM的鉴别诊断之一。
