以反覆性頭暈表現之鎖骨下竊血症候群

Subclavian Steal Syndrome Presenting with Recurrent Dizziness

頭暈是臨床常見主訴，背後隱藏著多樣化的疾病。本案例是一位55歲女性患者，因反覆性頭暈而頻繁就醫長達三年，皆以自律神經失調症診斷處置，但症狀未改善。此次因頭暈合併呼吸困難及肢體麻木入院，於入院身體評估檢查發現兩側上臂收縮壓差異達40mmHg，左手尺橈動脈搏動消失，因頸動脈杜普勒超音波發現左側鎖骨下動脈狹窄併有左側椎動脈逆流現象，進而經由血管電腦斷層掃描診斷為左側鎖骨下竊血症候群，隨即接受經皮腔內血管成形術及支架置入，術後頭暈終獲得改善。面對此類反覆性頭暈患者，建議常規測量兩側上臂血壓與檢查四肢脈搏，作為疾病鑑別診斷的重要訊息，以免延誤診斷而影響病患的生活品質。

Dizziness is a common clinical manifestation associated with a broad range of underlying conditions. We present the case of a 55-year-old female patient with recurrent dizziness for over 3 years, who had repeatedly sought medical treatment. The patient was diagnosed with dysautonomia on each occasion; however, her symptoms did not improve in response to treatment. The patient was admitted with a primary complaint of dizziness accompanied by difficulty in breathing and limb numbness. During the physical examination, the difference in systolic pressure between the two upper arms was 40 mmHg, and the pulse in the left ulnar and radial arteries was absent. Carotid artery Doppler ultrasonography revealed stenosis of the left subclavian artery accompanied by retrograde flow in the left vertebral artery. Subsequent computed tomography angiography confirmed the diagnosis of left subclavian steal syndrome. The patient underwent percutaneous transluminal angioplasty and stent placement, which improved her dizziness. Therefore, in patients with recurrent dizziness, routine measurement of blood pressure in both upper arms and assessment of pulse rate in all limbs are recommended to obtain sufficient data for differential diagnosis and to prevent a delayed diagnosis that may adversely affect the quality of life.