以打嗝為初始表現之椎動脈剝離個案報告

Newly Onset Hiccups with Vertigo as Initial Presentation of Left Vertebral Artery Dissection: A Case Report

顱內椎動脈剝離為一可能危及生命之疾病，其臨床表現十分多變。常見臨床症狀包含頭痛、暈眩、頸部疼痛、步態不穩、視覺或感覺缺損等等。本個案報告報導以打嗝及暈眩為初始表現之椎動脈剝離病例。病患為六十六歲男性診斷為左側椎動脈剝離合併左側延腦梗塞，初始以打嗝及暈眩表現，並惡化出現外側延髓症候群，後續磁振造影及血管攝影均證實左側椎動脈剝離之影像。本個案報告強調單純打嗝及暈眩可以為椎動脈剝離之唯一初始症狀。

Intracranial vertebral artery (VA) dissection is a life-threatening condition with varies clinical manifestations including headache, vertigo, neck pain, ataxia, visual or sensory deficit. However, reports regarding initial presentation of solely having hiccups followed by vertigo in patients with VA dissection remain sparse. We report a 66-year-old man diagnosed with left medullary infarction secondary to left VA dissection, initially presented with newly onset hiccups and followed by vertigo, with rapid progression to the symptoms compatible with Wallenberg syndrome within twelve hours. The result of brain magnetic resonance image demonstrated intramural hematoma and dissecting stenosis of left VA. The followed up computed tomography angiography in 10 days after symptom onset showed tapering end of left VA with partial flow restoration. Our report highlights that newly onset hiccups could be the first isolated symptom of VA dissection and rapid progression of clinical symptoms should be considered.