반복적인 의식저하와 전신마비를 보인 기저형 편두통 1례

A Case of Basilar Migraine Showing Repeated Change of Consciousness and Generalized Paralysis

저자들은 두통의 13세 남아에서 구토，복시，구음 장애，약 30분간의 의식 소실，어지러움，양측 감각 이상 이후에 심한 두통이 나타나는 증상이 간헐적으로 반복되는 기저형 편두통 환자에서 flunarizine 및 topiramate 병 합 예방요법으로 효과를 보인 1례를 경험하였기에 보고하는 바이다. 기저형 편두통은 전조 증상으로 드물게 의식장애나 양측 동시의 감각이상 등을 나타내므로 진단 빛 치료에 있어 이에 대한 고려가 필요하며 예방요법의 시행에 있어 단일약물로 효과가 없는 경우 flunarizine 및 topiramate 등의 병합 예방요법을 고려할 필요가 있다.

Basilar migraine is a rare type of migraine with complex symptoms including aura such as dysarthria, vertigo, tinnitus, and decreased level of consciousness. A 13-year-old male patient was presented with severe headache and immobility of whole body for 20 minutes after vomiting, dizziness, and dysarthria. Similar episode of headache and unconsciousness after vomiting happened 2 weeks ago prior to the visit. Vital signs were stable and pupils showed positive light reflex. Brain MRI and MRA, EEG, and electrocardiography revealed no abnormality. One day after discharge from hospital, patient revisited emergency room because of similar episode of headache. Preventive medication was started with flunarizine 5 mg per day. However, similar episodes of headache and loss of consciousness repeated three times over the next four months. Topiramate was then added with dose of 100 mg divided into two doses. Since then, the patient has been symptom free over 1 year.