Tanaka Jun, Yakushiji Yusuke, Nanri Yusuke, Kajiwara Masataka, Suda Kenji, Hara Hideo
Department of Internal Medicine, Saga University Faculty of Medicine, Japan.
Rinsho Shinkeigaku. 2013;53(8):638-41. doi: 10.5692/clinicalneurol.53.638.
A 38-year old man with an 8-year history of migraine with subclinical abnormal brain lesions on MRI was admitted to our hospital. His migraine attacks followed visual disturbance or dysarthria. Brain MRI revealed old infarctions restricted to the posterior circular region. On transesophageal cardiography, an atrial septal defect (ASD) was detected, and a bubble study showed an immediate appearance of many bubbles in the left atrium via ASD without Valsalva maneuver. The bubble study on transcranial-color-flow imaging also detected micro-embolic signals at the left vertebral artery and the left middle cerebral artery without Valsalva maneuver. Since paradoxical embolism via ASD was highly suspected and Qp/Qs was more than 1.5, transcatheter closure of ASD using AMPLATZER(®) Septal Occluder was performed. At a 2-year follow up, no recurrence of either migraine or infarction was found. This case indicates the relevance of right-to-left shunt to migraine with aura, as well as the usefulness of transcatheter closure of ASD using AMPLATZER(®) Septal Occluder for treatment of migraine with aura.
一名38岁男性，有8年偏头痛病史，MRI显示有亚临床异常脑病变，入住我院。他的偏头痛发作伴有视觉障碍或构音障碍。脑部MRI显示陈旧性梗死局限于后循环区域。经食管心脏超声检查发现房间隔缺损（ASD），气泡试验显示在未进行瓦尔萨尔瓦动作的情况下，通过ASD左心房立即出现许多气泡。经颅彩色血流成像的气泡试验在未进行瓦尔萨尔瓦动作的情况下，也在左椎动脉和左大脑中动脉检测到微栓塞信号。由于高度怀疑通过ASD发生反常栓塞且肺循环血流量与体循环血流量之比大于1.5，遂使用AMPLATZER®房间隔封堵器行经导管ASD封堵术。在2年的随访中，未发现偏头痛或梗死复发。该病例表明右向左分流与伴先兆偏头痛的相关性，以及使用AMPLATZER®房间隔封堵器行经导管ASD封堵术治疗伴先兆偏头痛的有效性。
