電子期刊
台灣家庭醫學雜誌
個案報告(Case Report)
獵弓症候群
獵弓症候群、椎動脈發育不全、椎基底動脈循環不全、asbestos、mesothelioma、pleural plague、occupational exposure
張馨丰1,2
、陳建志3
、陳登郎4
中國醫藥大學附設醫院教學部1
、中國醫學大學中醫學院中醫學系2
、佛教慈濟綜合醫院台中分院神經科3
、吉豐診所4
一50歲男性，罹患高血壓已經10年，屢屢因頭向左轉引起陣發性的頭暈已經7年，某日因頭暈持續，合併噁心超過1日而求診。眼振電圖顯示兩側視運動性眼振表現不良且頻次減少。腦部磁振造影無異常發現，但血管磁振造影顯示左側椎動脈發育不全，穿顱彩色動脈超音波檢查顯示頭向左轉時可使右側椎動脈及基底動脈的血流速變慢。診斷為椎動脈發育不全併發獵弓症候群，引起兩側橋腦凝視中心、內側縱束及外旋神經核功能不良。建議服用抗血小板劑及生活習慣調整以防止復發。由於獵弓症候群臨床上並不多見，大部分的第一線醫師對此病並不熟悉；嚴重時會併發腦幹或小腦症狀，有的會被誤認是美尼爾氏病；倘若與良性陣發性姿態性眩暈症共同致病時，會更加難以分辨。
（台灣家醫誌2015; 25: 151-156）DOI: 10.3966/168232812015062502005
Asbestos has been found to induce lung diseases, nobtably malignant mesothelioma, lung cancer, asbestosis, pleural plaques, and diffuse pleural thickening. We reported two cases of asbestos-related lung disease. One had malignant mesothelioma and the other was diagnosed with pleural plaque. The first case was a 62-year-old woman who suffered from chest pain, shortness of breath, and productive cough for 1 week. Chest X-ray revealed considerable right-sided pleural effusion, and pleural biopsy later confirmed the diagnosis of malignant mesothelioma. She had worked as a flame cutter in the shipbreaking industry for 7 years in Kaohsiung since she was 19 years old. The second case was a 72-yearold man reporting no previous chest discomfort. Bilateral pleural plaques were found accidentally when he was admitted to the hospital due to acute pancreatitis. Both chest radiography and computed tomography showed bilateral calcified pleural plaques. He had worked in pipe insulation business for 40 years since he was 24. The two cases have no longer in direct occupational exposure to asbestos for approximately 30-40 years. We performed literature review on pleural plaque, malignant mesothelioma, and the relationship between the two diseases. In spite of the fact that asbestos has been progressively banned, family physicians should continue paying attention to inquiring into previous hisotry about occupational exposure to asbestos because previous exposure to asbestos, even a distant one, may still raise the risk of asbestos-related diseases due to its long latent period. Family physicians are therefore advised to make inquiry into a patient's work experience and occupational exposure to asbestos as an essential part of their assessment and diagnosis. In addition, competent authorities should take the initiative to help patients with asbestos-induced diseases apply for workers' compensation.
(Taiwan J Fam Med 2015; 25: 157-164) DOI: 10.3966/168232812015062502006
（台灣家醫誌2015; 25: 151-156）DOI: 10.3966/168232812015062502005
Asbestos has been found to induce lung diseases, nobtably malignant mesothelioma, lung cancer, asbestosis, pleural plaques, and diffuse pleural thickening. We reported two cases of asbestos-related lung disease. One had malignant mesothelioma and the other was diagnosed with pleural plaque. The first case was a 62-year-old woman who suffered from chest pain, shortness of breath, and productive cough for 1 week. Chest X-ray revealed considerable right-sided pleural effusion, and pleural biopsy later confirmed the diagnosis of malignant mesothelioma. She had worked as a flame cutter in the shipbreaking industry for 7 years in Kaohsiung since she was 19 years old. The second case was a 72-yearold man reporting no previous chest discomfort. Bilateral pleural plaques were found accidentally when he was admitted to the hospital due to acute pancreatitis. Both chest radiography and computed tomography showed bilateral calcified pleural plaques. He had worked in pipe insulation business for 40 years since he was 24. The two cases have no longer in direct occupational exposure to asbestos for approximately 30-40 years. We performed literature review on pleural plaque, malignant mesothelioma, and the relationship between the two diseases. In spite of the fact that asbestos has been progressively banned, family physicians should continue paying attention to inquiring into previous hisotry about occupational exposure to asbestos because previous exposure to asbestos, even a distant one, may still raise the risk of asbestos-related diseases due to its long latent period. Family physicians are therefore advised to make inquiry into a patient's work experience and occupational exposure to asbestos as an essential part of their assessment and diagnosis. In addition, competent authorities should take the initiative to help patients with asbestos-induced diseases apply for workers' compensation.
(Taiwan J Fam Med 2015; 25: 157-164) DOI: 10.3966/168232812015062502006
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