Background

Isolated middle cerebral artery dissection is uncommon and occurs in patients reporting headaches as the only symptom. This makes intracranial artery dissection challenging to diagnose and treat.

Case description: We describe two cases of positional headache caused by isolated middle cerebral artery dissection, confirmed using high-resolution magnetic resonance imaging. The two patients presented with sudden-onset headache, occurring when lying in the lateral decubitus position. When lying down in the decubitus position ipsilateral to the intracranial artery dissection, the headache aggravated and middle cerebral artery flow velocity increased on transcranial Doppler ultrasonography compared to when in the supine position. Both patients were treated with antiplatelet agents, and the headache completely resolved within 1–2 weeks.

Conclusion

We recommend additional imaging studies evaluating intracranial artery dissection as a cause of positional headache.

中文翻译：

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孤立性大脑中动脉夹层引起的位置性头痛：两例报告。

背景

孤立的大脑中动脉夹层并不常见，发生在以头痛为唯一症状的患者中。这使得颅内动脉夹层的诊断和治疗具有挑战性。

病例描述：我们描述了两例由孤立的大脑中动脉夹层引起的位置性头痛，经高分辨率磁共振成像证实。这两名患者表现为突发性头痛，发生在侧卧位时。与仰卧位相比，在颅内动脉夹层同侧卧位卧床时头痛加重，大脑中动脉血流速度增加。两名患者均接受抗血小板药物治疗，头痛在 1-2 周内完全缓解。

结论

我们建议进行额外的影像学检查，评估颅内动脉夹层是位置性头痛的原因。