経皮的カテーテル心房中隔欠損孔閉鎖術により前兆のある片頭痛が消失した1例  [in Japanese] A case of migraine with aura attenuated by transcatheter closure of atrial septal defect  [in Japanese]

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Author(s)

    • 田中 淳 Tanaka Jun
    • 佐賀大学医学部神経内科 Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine
    • 南里 悠介 Nanri Yusuke
    • 佐賀大学医学部神経内科 Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine
    • 梶原 正貴 Kajiwara Masataka
    • 佐賀大学医学部循環器内科 Department of Cardiology, Department of Internal Medicine, Saga University Faculty of Medicine
    • 須田 憲治 Suda Kenji
    • 久留米大学医学部小児科 Department of Pediatrics and Child Health, Kurume University School of Medicine
    • 原 英夫 Hara Hideo
    • 佐賀大学医学部神経内科 Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine

Abstract

症例は38歳男性である.8年前より前兆のある片頭痛があった.MRIで陳旧性脳梗塞巣があり,経食道心臓超音波検査で右左シャントを証明した.心臓カテーテル検査の結果をえて,陳旧性脳梗塞巣は心房中隔欠損に関連したものと診断した後,AMPLATZER<sup>®</sup> Septal Occluderをもちいた閉鎖術をおこなった.術後,右左シャント量は著減した.術後2年の経過中に片頭痛はなく,MRI上の新規脳梗塞もなかった.本症例は,前兆のある片頭痛には右左シャントが関与するものが存在することを支持し,心房中隔欠損症であれば同デバイスによる閉鎖術が有効である可能性を示した.

A 38-year old man with an 8-year history of migraine with subclinical abnormal brain lesions on MRI was admitted to our hospital. His migraine attacks followed visual disturbance or dysarthria. Brain MRI revealed old infarctions restricted to the posterior circular region. On transesophageal cardiography, an atrial septal defect (ASD) was detected, and a bubble study showed an immediate appearance of many bubbles in the left atrium via ASD without Valsalva maneuver. The bubble study on transcranial-color-flow imaging also detected micro-embolic signals at the left vertebral artery and the left middle cerebral artery without Valsalva maneuver. Since paradoxical embolism via ASD was highly suspected and Qp/Qs was more than 1.5, transcatheter closure of ASD using AMPLATZER<sup>®</sup> Septal Occluder was performed. At a 2-year follow up, no recurrence of either migraine or infarction was found. This case indicates the relevance of right-to-left shunt to migraine with aura, as well as the usefulness of transcatheter closure of ASD using AMPLATZER<sup>®</sup> Septal Occluder for treatment of migraine with aura.

Journal

  • Rinsho Shinkeigaku

    Rinsho Shinkeigaku 53(8), 638-641, 2013

    Societas Neurologica Japonica

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