獵弓症候群

Bow Hunter's syndrome, vertebral arterial hypoplasia, vertebrobasilar insufficiency

一50男性，罹患高血壓已經10年，屢屢因頭向左轉引起陣發性的頭暈已經7年，某日因頭暈持續，合併噁心超過1日而求診。眼振電圖顯示兩側視運動性眼振表現不良且頻次減少。腦部磁振造影無異常發現，但血管磁振造影顯示左側椎動脈發育不全，穿顱彩色動脈超音波檢查顯示頭向左轉時可使右側椎動脈及基底動脈的血流速變慢。診斷為椎動脈發育不全併發獵弓症候群，引起兩側橋腦凝視中心、內側縱束及外旋神經核功能不良。建議服用抗血小板劑及生活習慣調整以防止復發。由於獵弓症候群臨床上並不多見，大部分的第一線醫師對此病並不熟悉；嚴重時會併發腦幹或小腦症狀，有的會被誤認是美尼爾氏病；倘若與良性陣發性姿態性眩暈症共同致病時，會更加難以分辨。

Results: A total of 79,052 men and 72,587 women were enrolled. The prevalence of gallstone disease read respectively 5.9% overall, 6.4% in male subjects, and 5.3% in female subjects. Overweight and obesity increased the risk of gallstone disease by nearly 50%. In multivariate analysis controlled by age, body mass index, history of hypertension and diabetes, lower HDL-C emerged to be positively associated with gallstone disease in both genders, adjusted OR1.14 (1.08-1.21) in men and adjusted OR 1.28 (1.17-1.48) in women. Moreover, hypercholesterolemia (OR 1.13 [1.02-1.25]) and high LDL-C (OR 1.1 [1.06-1.27]) were further identified as the risk factors for gallstone disease in women.