Artery Dissection and Headache 神經內科林高章醫師奇美醫學中心.

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Artery Dissection and Headache 神經內科林高章醫師奇美醫學中心

Case 1 45yrs, female, uterine myoma s/p in 90-2, at VGH-Taipei. Bokey during 90-92’s, for pregnancy used. Deny systemic disease-HTN, DM, etc. No family history, no migraine history. C.C  Sudden onset of left hand grasping weakness on , clumsy and sore. Slurred speech on , and visited Chi-Mei ER. No progressive weakness. Right temporal pulsatile headache on moving heavy things 1-day before stroke, mild intensity, duration for minutes, without further associated symptoms. (reminding recall).

190/110, 88/min, no fever, supple neck. PE: NP (no murmur, no carotid bruits) NE (+): mp 3+/5, distal clumsy hand, slurred speech. Lab(+): CRP=18.5 (<3), Hb=10.7, LDL=149mg (T-211) Protein-C, S, anti-thrombin-III, thyroid: negative. Cardiac echo: normal chamber size (LVEF=59%), no vegetation. Carotid echo: mild atherotic change (0/.8/0.6-IMT), ICAs flowmeter (421/486 ml/m) CT and MRA: pending.

CT ( )

MRI ( )

MRA f/u 1 m later ( )

MRI 1 m later ( )

MRA f/u (99-2-8)

MRA f/u ( )

MRI f/u ( )