Trigemino-autonomic headache related to Gasperini syndrome

Cephalalgia, 2009

Trigeminal neuralgia (TN) is a common unilateral disorder characterized by brief electric shock-like pains, abrupt in onset and termination, limited to the distribution of one or more divisions of the trigeminal nerve. Indeed, pain is commonly evoked by trivial stimuli, including washing, shaving, smoking, talking, or brushing the teeth and frequently occurs spontaneously (1). Cluster headache (CH), short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT), short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms, and paroxysmal hemicrania (PH) are classified as trigeminal-autonomic cephalalgias (TACs). These cephalalgias, according to International Classification of Headache Disorders, 2nd edn (ICHD-II) criteria, share the clinical features of headache accompanied by cranial parasympathetic autonomic features (1). These syndromes seem to be different and well-characterized. However, in recent years some cases have been described in which syndromes co-existed or switched from one type to another in the same patient. This event raised doubt that there could be some common mechanisms among them. We describe a patient who resurrects this problem. She first presented with TN, later developed SUNCT, and then manifested TN attacks, followed by CH, and finally SUNCT without TN attacks.

Cephalalgia, 2001

Annals of Case Reports and Images, 2018

Cephalalgia, 2008

Headache Medicine

IntroductionIn Brazil there is only one case report of a patient diagnosed with Paroxysmal Hemicrania-Trigeminal (PH-Tic) syndrome reported, however it was observed in a patient with Chiari I malformation.ObjectiveHere, we describe the first case of primary PH-Tic syndrome in the country.MethodCase report. CARE guideline was used to guide the structuring of this article. This case report was approved by the ethics committee and has been registered under the protocol number 70705623.7.0000.5440 on “Plataforma Brasil”.ResultsA 72-year-old woman with a five-month history of headaches was admitted at our headache outpatient clinic. The pain was sharp, intense, localized in the periorbital and left temporal regions. Blood counts, liver, renal and thyroid function were normal, as well as brain magnetic resonance imaging. Despite using carbamazepine, the patient had pain in only the left side of the face. Indomethacin was added until the dose of 100 mg a day and resulted in improvement of ...

The Journal of Headache and Pain, 2010

The trigeminal autonomic cephalalgias (TACs), including cluster headache, paroxysmal hemicrania and SUNCT, are characterized by the cardinal combination of short-lasting unilateral pain and autonomic phenomena affecting the head. Hemicrania continua (HC) shares many clinical characteristics with TACs, including unilateral pain and ipsilateral autonomic features. Nevertheless, HC is separately classified in the revised International Classification of Headache Disorders (ICHD-II). Here, we describe the case of a 45-year-old man presenting an unusual concurrence of different forms of primary headaches associated with autonomic signs, including subsequently ipsilateral cluster headache, SUNCT and HC. This report supports the theory that common mechanisms could be involved in pathophysiology of different primary headache syndromes.

Cephalalgia, 2016

Background: Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) or with autonomic symptoms (SUNA) are grouped together within the trigeminal autonomic cephalalgias (TACs). However, the SUNCT and SUNA phenotype and management overlap with those of trigeminal neuralgia (TN). Additionally, a broad variety of cerebral pathologies are reportedly able to trigger either TN-or SUNCT-like pain, and emerging structural neuroimaging findings suggest the possible role of neurovascular conflict with the trigeminal nerve in SUNCT, further supporting aetiological and pathophysiological overlaps among SUNCT, SUNA and TN. Case report: We present the first case of coexisting chronic SUNCT-and TN-like phenotypes caused by haemorrhagic infarct of the dorsolateral medulla. Discussion: In light of our case, a perturbation of the dorsolateral medullary circuits may constitute an important pathophysiological component, supporting a unifying nosological hypothesis that considers SUNCT, SUNA and TN clinical variants of the same disorder.

SVOA Neurology, 2023

Trigeminal neuralgia, a chronic neuropathic pain, is characterized by frequent episodes of stabbing facial pain, in the territory of the trigeminal nerve, which can severely impair patient's quality of life. It is primarily caused by vascular compression of the trigeminal nerve root, but it is sometimes secondary to other identifiable neurological conditions, such as multiple sclerosis or a cerebellopontine angle tumor. Uncommonly, it may be caused by the presence of idiopathic intracranial hypertension, a condition most likely identified by headache, visual disturbances, and sixth nerve palsy, among other manifestations. Secondary causes of trigeminal neuralgia are usually detected after an atypical clinical manifestation, such as ophthalmic rather than maxillary or mandibular nerve involvement, more than one branch affected, or bilateral symptoms. We present a patient who presented with trigeminal neuralgia as a primary manifestation, and after thorough evaluation she was diagnosed with intracranial hypertension as the underlying mechanism responsible of the trigeminal neuralgia.

Cephalalgia, 2018

Background Short-lasting unilateral neuralgiform headaches include those with conjunctival injection and tearing and with cranial autonomic symptoms. Most frequently reported as idiopathic, there is a growing number of symptomatic cases described. Case report A 57-year old man presented a 16-year history of right hemifacial short-lasting pain attacks accompanied by ipsilateral autonomic symptoms and simultaneous malar contractions. Brain MRI disclosed a right acoustic neuroma compressing the right facial nerve and a venous developmental anomaly perpendicular to the right facial nerve root entry zone, without lesions affecting the trigeminal nerve. He was started on lamotrigine, resulting in complete remission of pain attacks, autonomic signs and facial contractions. Conclusions This patient presents a typical short-lasting unilateral neuralgiform headache with response to lamotrigine. The uniqueness of the case is the co-occurring malar contractions, evocative of facial nerve involv...

Clinical Oral Investigations, 2012

An abnormal vascular course of the superior cerebellar artery is often cited as the cause for trigeminal neuralgia. However, among patients with TN-like symptoms, 6% to 16% are variously reported to have intracranial tumours. Aneurysms, tumours, or other lesions may impinge or irritate the trigeminal nerve along its course. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. We would like to present a series of unusual lesions, all of which initially presented with neuralgic-like symptoms and were refractory to treatment. Collated case series with photographs and imaging are reviewed in this paper. Discussion of case presentation and management are done for evaluation. A wide range of other compressive lesions can cause trigeminal neuralgia. This paper illustrates the clinical presentation of atypical trigeminal neuralgia and emphasises the value of diagnostic imaging in trigeminal neuralgia patient. Suggested algorithm for management of trigeminal neuralgia