전조성 편두통 양상을 보인 척추동맥 협착으로 인한 반복적인 일과성 허혈증

Abstract

Background : The relationship between migraine and ischemic stroke remains controversial. We report a patient with transient ischemic attacks that mimicked migraineous headache. Case Report : We describe a 65-year-old hypertensive and diabetic man who was admitted to Asan Medical Center due to vertigo, headache and paresthesia in the left arm and leg. Prior to this event, the patient had suffered from recurrent, intense frontal headache lasting several hours for three years. The frequency of the headache varied from several times a day to once in several months. Scintillating scotoma lasting approximately for one minute always preceded the headache. On examination, he had left homonymous hemianopia and right-sided paresthesia with slightly decreased pinprick sensations. MRI showed infarcts in the right posterior cerebral artery(PCA) territory, and cerebral angiogram showed severe stenosis of the left vertebral-basilar artery junction and occluded right PCA. He was treated with heparin, which was switched to coumadin. He never experienced headache until at 3 years of follow-up although there remained left inferior quadrantanopia. Conclusion : The recurrent headache attacks of this patient resemble migraine with aura. However, prolonged cessation of the headache by anticoagulation suggests that the migraine attacks may be transient ischemic attacks due to recurrent thromboembolism. Korean Journal of Stroke 2001;3(2): 177~179