심방중격결손폐쇄술 후 발생한 시각 조짐을 동반한 편두통 1예
A Case of Migraine with Aura Related to the Percutaneous Closure of Atrial Septal Defect
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목적: 심방중격결손 환자에서 경피적 심방중격결손폐쇄술 후 발생한 시각 조짐을 동반한 편두통 증례를 보고하고자 한다. 증례요약: 58세 여자 환자가 3일 전부터 시작된 우안의 섬광 및 눈부심을 주소로 내원하였다. 환자는 3주 전 경피적 심방중격결손폐쇄술을 시행 받은 상태였으며, 안과적 검사상 특이 소견이 발견되지 않아 경과관찰하였다. 2달 후 환자는 더욱 심해진 눈부심, 섬광 및 광선공포증으로 다시 방문하였다. 섬광 이후 뒤쪽으로 뻗치는 양상의 두통을 호소하여 비로소 시각 조짐을 동반한 편두통을 의심하여 신경과 협진을 시작하였다. 환자는 심방중격결손폐쇄술 후 새롭게 발생한 편두통으로 진단 받았고, 복용 중이던 acetylsalicylic acid를 clopidogrel로 변경한 후 두통이 바로 호전되었으며, 치료 1주 후부터 1년 후까지 안과적 증상과 두통의 재발이 없었다. 결론: 경피적 심방중격결손폐쇄술 시행 후 편두통이 새롭게 발생될 수 있다. 섬광, 눈부심 등을 주소로 환자가 내원하였을 때, 조짐을 동반한 편두통 및 이차적 원인에 의한 편두통을 염두에 두고, 자세한 병력 청취를 통해 편두통을 조기에 진단할 수 있도록 해야 할것이다.
Abstract
Purpose: To report a case of migraine attacks with aura that occurred after percutaneous closure of an atrial septal defect (ASD) with the Amplatzer septal occluder device. Case summary: A 58-year-old female presented with glare and scintillation that lasted 3 days. She had a history of percutaneous ASD intervention 3 weeks prior. Because ophthalmologic examination revealed nothing remarkable, the patient underwent observation. However, two months later, she revisited our department, presenting with aggravated glare, scintillation, and severe photophobia. Also, she presented with scintillation followed by a headache starting from the right temporal area extending to the occipital area. The patient was diagnosed with migraine with aura, which was newly developed after percutaneous ASD closure. After switching medication from acetylsalicylic acid to clopidogrel, the frequency and intensity of the headaches were reduced. No recurrence of ophthalmic symptoms or headache was observed during the 1-year follow-up. Conclusions: Percutaneous closure of ASD can be complicated by the appearance of migraine attacks with aura. When patients present with glare and scintillation, ophthalmologists must consider the possibility of migraine with aura and migraine induced by secondary causes. Thus, detailed history taking should be taken in order to make an early diagnosis of migraine.
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