併發陣發性頭暈之椎基底動脈扭曲及兩側顱內椎動脈狹窄

Tortuous Vertebral-basilar Artery and Bilateral Intracranial Vertebral Artery Stenosis Presenting with Episodic Dizziness

椎基底動脈扭曲及兩側顱內椎動脈狹窄可能會僅僅併發陣發性頭暈。一名53 歲男性，每日反覆頭暈及耳鳴發作已經5 年多。在一次的突然眩暈發作後，每日白天均會有持續性的頭暈，直至傍晚。姿態變化可以引發類似的頭暈，心電圖、醒覺腦波圖與血液學檢查均為正常。純音聽力檢查顯示左側聽閾較右側高，眼振電圖及兩側氣導震動式頸肌前庭誘發肌性電位檢查呈現中樞性的障礙。血管磁振造影呈現椎基底動脈扭曲及兩側顱內椎動脈狹窄。建議保守治療及生活習慣調整避免突然的起身動作，往後1 個月，頭暈發作減少，遂停止服藥。追蹤迄今已1 年，情況依然穩定，調整生活習慣避免突然的起身動作可能是減少病症發作的原因。

Tortuous vertebral-basilar artery and intracranial vertebral artery stenosis might simply present with episodic dizziness. A 53-year-old man suffered from congenital hemangioma of his right face. He had been bothered by episodic dizziness with tinnitus for over five years. He was sent to our emergency room because of sudden vertigo. Following the accident, dizziness was constant in the daytime until the evening. The dizziness could be induced when he abruptly sat up from a lying position. An electrocardiogram and a waking electroencephalogram did not show any abnormality. All blood examinations were within normal ranges. A pure tone audiometry showed the average hearing threshold was higher in the left than the right. An electronystagmogram and an air-conduction vibrationcervical vestibular evoked myogenic potential demonstrated central impairment. The magnetic resonance angiography showed tortuosity of the vertebral-basilar artery, and stenosis of the bilateral intracranial vertebral artery. Thus, conservative treatment and life-style change, avoiding sudden standing, were recommended. Over the following month, the dizziness recurred less and less, although left-sided tinnitus persisted and therefore medication was halted. Over the following year, the dizziness became rare. It is possible life-style changes and avoidance of sudden standing can prevent episodic dizziness.