伴自主神经症状的心脏源性头痛1例报告并文献复习  

Cardiac Cephalalgia with Autonomic Nerve Symptoms:A Case Report and Literature Review

作　　者：许佳 张海峰[1] 陈媛[1] 连亚军[1] XU Jia;ZHANG Hai-feng;CHEN Yuan;LIAN Ya-jun(Department of Neurology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院神经内科,郑州450000

出　　处：《神经损伤与功能重建》2022年第12期742-745,共4页Neural Injury and Functional Reconstruction

摘　　要：目的:总结心脏源性头痛(CC)的临床特点,以提高临床医生对本病的认识和早期诊断率。方法:报道1例就诊于我院的伴自主神经症状的CC患者,并检索1997年1月至2021年10月医学文献中报道的CC患者进行总结。结果:本院收治的1例CC患者表现为双侧颞顶枕部胀痛,视觉模拟评分(VAS)7~8分,同时伴随恶心、畏光、畏声、胸闷、呼吸困难及流涎、流泪、流涕等自主神经症状。动态心电图示头痛发作时快心律依赖性广泛心肌缺血,冠状动脉CT血管成像提示三支病变。抗心绞痛治疗有效。搜索既往报道的CC患者45例,临床表现为活动诱发的中重度头痛,部位多样,以搏动样、压迫性为主,伴随胸部不适、恶心、心悸和出汗,持续时间多在1 h内,休息或服用硝酸甘油缓解。结论:CC是一种少见疾病,对于超过50岁,活动诱发的中、重度头痛患者,如伴典型心血管病危险因素,应想到CC的可能。尽早确诊和规范的抗心绞痛治疗可改善患者预后。Objective:To analyze the clinical characteristics of cardiac cephalalgia(CC)and improve the understanding and diagnosis accuracy of this disease.Methods:A case of CC with autonomic symptoms from our hospital was reported.Medical literature from January 1997 to October 2021 was searched for patients diagnosed with CC,and the findings were summarized.Results:The patient in this case report presented bilateral temporoparietal pulsating headaches and a visual analog scale(VAS)score of 7~8 accompanied by nausea,photophobia,phonophobia,chest tightness,dyspnea,and autonomic symptoms such as salivation,tearing,and runny nose.Homomorphic ECG showed rapid rhythm-dependent extensive myocardial ischemia during headache attacks.Coronary artery CTA suggested three-vessel disease.Anti-angina pectoris treatment was effective.Forty-five cases of CC were reviewed.The clinical manifestations were mainly activity-induced,moderate to severe headaches in various locations,mostly pulsating and compressive,and accompanied by chest discomfort,nausea,palpitations,and sweating.The duration was mostly under 1 hour,and symptoms were relieved by rest and nitroglycerin.Conclusion:CC is a rare disease.Patients over 50 years old with activity-induced,moderate to severe headache combined with typical cardiovascular disease risk factors should be highly suspected of having CC.Early diagnosis and anti-angina therapies could contribute to good prognosis.

关 键 词：心脏源性头痛 头痛 心肌缺血 自主神经症状 

分 类 号：R741[医药卫生—神经病学与精神病学] R741.02[医药卫生—临床医学] R742R743