脑淀粉样血管病中的复发性刻板发作：两名患者对偏头痛预防性治疗的反应
Recurrent stereotyped episodes in cerebral amyloid angiopathy: response to migraine prophylaxis in two patients.
作者信息
Paterson R W, Uchino K, Emsley H C, Pullicino P
机构信息
National Hospital for Neurology and Neurosurgery, London, UK.
出版信息
Cerebrovasc Dis Extra. 2013 May 18;3(1):81-4. doi: 10.1159/000347114. Print 2013 Jan.
BACKGROUND
Cerebral amyloid angiopathy (CAA) typically presents with cognitive decline or symptomatic intracerebral hemorrhage, but episodes of recurrent stereotyped limb attacks have also been reported.
METHODS
Retrospective review of the medical records of 4 patients referred to the general neurology services and a specialist stroke center with clinically probable CAA.
RESULTS
Four subjects, all Caucasian, mean age 74 years, were followed up over a mean duration of 20 months. They all experienced recurrent prolonged stereotyped attacks of sensory symptoms, lasting 5-30 min, that resolved completely between attacks. Three subjects developed intracerebral hemorrhage, and 2 had an irreversible rapid cognitive decline. Two patients experienced symptomatic improvement with migraine prophylaxis (verapamil or topiramate).
CONCLUSIONS
Recurrent stereotyped prolonged attacks with sensory and motor elements can predate the development of intracerebral hemorrhage in individuals with clinically probable CAA. When evaluating patients with such attacks, neurologists need to consider CAA as a possible mimic of transient ischemic attacks. We suggest a trial of migraine prophylaxis for symptomatic management.
背景
脑淀粉样血管病（CAA）通常表现为认知功能下降或有症状的脑出血，但也有复发性刻板性肢体发作的报道。
方法
回顾性分析4例转诊至普通神经科和专科卒中中心、临床诊断可能为CAA患者的病历。
结果
4例患者均为白种人，平均年龄74岁，平均随访20个月。他们均经历了复发性、持续时间较长的刻板性感觉症状发作，持续5 - 30分钟，发作间期完全缓解。3例患者发生脑出血，2例出现不可逆的快速认知功能下降。2例患者使用偏头痛预防性药物（维拉帕米或托吡酯）后症状改善。
结论
在临床诊断可能为CAA的个体中，伴有感觉和运动成分的复发性刻板性长时间发作可先于脑出血出现。在评估有此类发作的患者时，神经科医生需要考虑CAA可能是短暂性脑缺血发作的一种模拟疾病。我们建议进行偏头痛预防性治疗试验以进行症状管理。
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