中英072JAMA注意这种头痛李蒙蒙

图1，该患者首次头痛发作时，伴左眼发红、流泪及眶周肿胀。

A24-year-oldwomanwasreferredtoourclinicforevaluationandtreatmentofafirst-everepisodeofheadachesthatoccurred16daysbeforetheconsultation.Shereportedastrongunilateralheadachelocatedinherleftcheek,eye,andforeheadthatevolvedduringtheeveninghours,peakedatnight,anddecreasedagainuntilthemorning,withoutanyremarkabletrigger.Thisfirstepisodewentalongwithipsilaterallacrimation,aredeye,andperiorbitalswellingbutwithoutptosis,whichshedocumentedwithhersmartphone(Figure1).Duringapainfulnight,shecouldnotsleep.Painremitted,buttheswellingincreaseduntilthenextmorningandslowlydecreasedoverapproximately36hours.Recurrentbutlessintenseepisodesofseveralhours’durationoccurredduringthe2subsequentnightswithnosymptomsduringthefollowing14days.Thepatientreportednonasalcongestion,nausea,vomiting,orphonophobiaorphotophobia.Thepatientreportedbeinganinfrequentsmoker,withabout2cigarettesamonth.

女性，24岁，缘于16天前首次发作头痛，为求诊治而就诊于我院门诊。患者自诉无明显诱因出现剧烈偏头痛，部位为左侧脸颊、左眼和前额，始于傍晚，夜间为著，直至清晨才逐渐缓解。患者首次偏头痛发作时，伴患眼发红、流泪及眶周肿胀，无眼睑下垂，见于上图患者手机拍下的照片（图1）。患者首次发作头痛当晚，因疼痛难耐无法入睡。次日晨，患者疼痛缓解，但眶周肿胀加剧，于36小时内逐渐减轻。在随后的2日夜间，上述症状曾反复发作，持续约几小时，但都不似之前首次发作时那么严重。此后14天内，未再出现上述症状。患者诉无鼻塞、恶心、呕吐及畏声、畏光，有吸烟史，但不频繁，约2支/月。

Shehadnohistoryofimpairedvision,diplopia,facialtrauma,priorheadornecksurgery,orallergies.Examinationofherheadandneckshowednoparticularities,periorbitaledemaorproptosis,orenlargedlymphnodes.Theneurologicalexaminationwasunremarkable,withnormalvisualacuity,symmetricallyreactivepupils,andunimpairedocularmovements,aswasadifferentialhemogram,whichshowednormalwhitebloodcellcountof/μL(toconvertto×/L,multiplyby0.).

患者否认既往视力受损、复视、面部创伤史、前额或颈部手术史及过敏史。头颈部查体无眶周水肿、眼球突出及淋巴结肿大等特殊情况。神经系统查体未见异常：视力正常，双侧瞳孔正大等圆，光反射灵敏，眼球运动正常。且该患者血象示白细胞计数正常，为/μL（乘以0.，可转换为×/L），分类计数也在正常范围。

WHATISYOURDIAGNOSIS?

A.Thefirstepisodeofclusterheadacheepisodes

B.Tolosa-Huntsyndrome,aretrobulbarinflammation

C.Aspace-occupyingmucoceleofthenasopharynx

D.Anacuteepisodeofangle-closureglau







































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