Tao Meichun, Yang Yaping, Cheng Hao, Dong Mei
Neurology Department, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
Imaging Department, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
Radiol Case Rep. 2024 Nov 25;20(2):1005-1008. doi: 10.1016/j.radcr.2024.10.131. eCollection 2025 Feb.
Severe headache as the initial clinical manifestation of early neurological deterioration (END) is uncommon. The emergence of severe headache should be promptly recognized as a potential indicator of large vessel stenosis. Here, we describe a male patient who initially presented with severe headache accompanied by transient left limb weakness, which subsequently progressed to persistent weakness. Imaging studies revealed severe stenosis at the origin of the right internal carotid artery, along with the presence of asymmetrically prominent cortical veins (APCV). Despite the administration of pregabalin orally and tramadol intramuscularly, his headache persisted. However, significant alleviation of his headache symptoms was observed following the improvement of cerebral perfusion. Re-examination revealed the resolution of cortical vein dilation. This case underscores the importance of recognizing severe headache and APCV as potential indicators of large vessel stenosis and early neurological deterioration (END). Improving cerebral perfusion may serve as an effective means of alleviating headache symptoms in such cases.
严重头痛作为早期神经功能恶化（END）的初始临床表现并不常见。严重头痛的出现应迅速被识别为大血管狭窄的潜在指标。在此，我们描述一名男性患者，其最初表现为严重头痛并伴有短暂性左下肢无力，随后进展为持续性无力。影像学研究显示右颈内动脉起始处严重狭窄，同时存在不对称突出的皮质静脉（APCV）。尽管口服了普瑞巴林并肌肉注射了曲马多，他的头痛仍持续存在。然而，随着脑灌注的改善，观察到他的头痛症状明显缓解。复查显示皮质静脉扩张消失。该病例强调了将严重头痛和APCV识别为大血管狭窄和早期神经功能恶化（END）潜在指标的重要性。改善脑灌注可能是缓解此类病例头痛症状的有效手段。
