Migraine Treated with Acyclovir
Migraine Treated with Acyclovir
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阿昔洛韦治疗偏头痛
DOI：
10.1111/j.1526-4610.2005.05082_6.x
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发表时间：
2005
期刊：
影响因子：
--
通讯作者：
S. de Bruijn
中科院分区：
文献类型：
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作者：
E. Peters;S. de Bruijn
Ferrante及其同事报告的12例自发性颅内低血压（SIH）患者中，没有一例以霹雳样头痛为首发症状。1我们认为SIH可能代表了一个迄今为止尚未被认识到的雷击性头痛的原因。一名先前健康的29岁右侧男性，因数小时的颈部头痛而就诊。头痛突然发作，放射回后颈部和肩胛间区域，并伴有呕吐和恐惧症;他报告站立或坐起时症状严重恶化，横卧位时几乎完全缓解。入院时，患者表现为急性疾病，无发热，警觉，完全定向，生命参数正常。除轻度颈部僵硬外，体格和神经系统检查结果正常，初步实验室检查结果也正常。未注射造影剂的脑计算机断层扫描（CT）未显示任何异常。腰椎穿刺时，开放压为30 mmH 2 O（参考范围，70 - 180 mmH 2 O），脑脊液（CSF）澄清无色，分析显示无红细胞或白细胞，蛋白质44 mg/dL，葡萄糖83 mg/dL。细菌、抗酸杆菌和酵母菌染色呈阴性，培养物未生长任何微生物;无寡克隆带。钆增强磁共振（MR）显示沿着整个大脑凸面和纵裂的弥漫性脑膜增强，伴少量硬膜下积液;无肿块效应或任何与肿瘤或脑膜感染一致的不规则增强模式。我们诊断为（SIH）。放射性核素脑池造影术和脊髓MR用于阐明CSF渗漏部位，但未能显示任何渗漏部位。患者在卧床休息、补液和皮质类固醇治疗后逐渐恢复，并于第34天出院。在1年后的随访访视时，最后一次见到他时，他情况良好，未报告任何并发症或头痛复发。
None of the 12 patients with spontaneous intracranial hypotension (SIH) reported by Ferrante and colleagues had a thunderclap headache as the first presenting symptom of their disorder. 1 We suggest that SIH may represent a so far under-recognized cause of thunderclap headache. A previously healthy, right-sided 29-year-old man presented with excruciating nuchal headache since several hours. Headache had an abrupt thunderclap onset, radiated back to the posterior neck and interscapular region, and was accompanied by vomiting and photophobia; he reported a severe worsening of symptoms with standing or sitting up and an almost complete relief with recumbent position. On admission, the patient appeared acutely ill, apyrexial, alert, and fully oriented with normal vital parameters. Findings of physical and neurological examinations were normal except for a mild neck stiffness and the initial laboratory findings were also normal. A brain computed tomographic (CT) scan without injection of contrast medium did not reveal any abnormality. At lumbar puncture, opening pressure was 30 mmH2O (reference range, 70 to 180 mmH2O) with clear and colorless cerebrospinal fluid (CSF) and analysis revealed no erythrocyte or leukocyte with protein 44 mg/dL and glucose 83 mg/dL. Staining was negative for bacteria, acid-fast bacilli, and yeast and cultures did not grow any organism; there were no oligoclonal bands. A gadolinium-enhanced magnetic resonance (MR) showed diffuse meningeal enhancement along the entire cerebral convexity and interhemispheric fissure with small subdural fluid accumulations; there was no mass effect or any irregular pattern of enhancement consistent with the presence of a tumor or meningeal infection.We made a diagnosis of (SIH). Radionuclide cisternography and spinal MR, which were performed to elucidate the site of CSF leaks, failed to show any site of leakage. The patient recovered gradually with bed rest, hydration, and corticosteroids and was discharged on the 34th hospital day. When last seen, at the follow-up visit 1 year later, he was doing well and did not report any complication or recurrence of headache.