MR Tractography in Short Lasting Unilateral Neuralgiform Headache Attacks with Conjunctival Injection and Tearing (SUNCT) Patients: Case Reports

Abstract Background. Short-lasting unilateral neuralgiform headache attack with conjunctival injection and tearing (SUNCT) is one of the trigeminal autonomic cephalalgias where neurovascular compression was detected in neuroimaging in recent years. Case. We report two cases, a 52-year-old adult and...

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Bibliographic Details
Published in:Pain medicine (Malden, Mass.) Mass.), 2017-07, Vol.18 (7), p.1377-1381
Main Authors: Coskun, Ozlem, Ucar, Murat, Vuralli, Doga, Yildirim, Funuzar, Cetinkaya, Rumeysa, Akın Takmaz, Suna, Ucler, Serap
Format: Article
Language:English
Subjects:
Aged
Autonomic nervous system
Case reports
Cluster Headache - complications
Cluster Headache - diagnostic imaging
Compression
Conjunctiva
Decompression
Diffusion Tensor Imaging - methods
Female
Geriatrics
Headache
Headaches
Humans
Hypothalamus
Injection
Magnetic resonance imaging
Magnetic Resonance Imaging - methods
Microvasculature
Middle Aged
Neuralgia
Neuroimaging
NMR
Nuclear magnetic resonance
Patients
Surgery
Tears
Trigeminal nerve
Trigeminal Neuralgia - complications
Trigeminal Neuralgia - diagnostic imaging
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Summary:Abstract Background. Short-lasting unilateral neuralgiform headache attack with conjunctival injection and tearing (SUNCT) is one of the trigeminal autonomic cephalalgias where neurovascular compression was detected in neuroimaging in recent years. Case. We report two cases, a 52-year-old adult and a 69-year-old elderly patient with short-lasting and recurrent headache combined with cranial autonomic features. Diffusion tensor imaging (DTI) and magnetic resonance (MR) tractography of both patients outlined structural changes of the trigeminal nerve revealing neurovascular compression. Pain and autonomic symptoms were completely relieved in the 52-year-old patient who underwent microvascular decompression surgery. Conclusion. To our knowledge, this is the first time in the literature where MR tractography revealed structural changes in the trigeminal nerve secondary to neurovascular compression in SUNCT patients. We suggest that in SUNCT patients high-resolution magnetic resonance imaging (MRI) and/or DTI-MR tractography should be performed to exclude neurovascular compression. We propose that the compression of the trigeminal nerve could generate SUNCT symptoms and the posterior hypothalamus could be activated secondarily. With this point of view, trigeminal neuralgia and SUNCT could represent the different features of the neurovascular compression spectrum.
ISSN:1526-2375
1526-4637
DOI:10.1093/pm/pnw334