scholarly journals Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing syndrome secondary to an epidermoid tumor in the cerebellopontine angle

2013 ◽  
Vol 34 (3) ◽  
pp. E1 ◽  
Author(s):  
Shaun D. Rodgers ◽  
Bryan J. Marascalchi ◽  
Russell G. Strom ◽  
Paul P. Huang
Keyword(s):  
Medical Treatment ◽  
Trigeminal Nerve ◽  
Cerebellopontine Angle ◽  
Signs And Symptoms ◽  
Definitive Treatment ◽  
Trigeminal Autonomic Cephalalgias ◽  
Conjunctival Injection ◽  
Total Resection ◽  
Sunct Syndrome ◽  
Epidermoid Tumor

Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) syndrome is classified under trigeminal autonomic cephalalgias. This rare headache syndrome is infrequently associated with secondary pathologies. In this paper the authors report on a patient with paroxysmal left retroorbital pain with associated autonomic symptoms of ipsilateral conjunctival injection and lacrimation, suggestive of SUNCT syndrome. After failed medical treatment an MRI sequence was obtained in this patient, demonstrating an epidermoid tumor in the left cerebellopontine angle. The patient's symptoms completely resolved after a gross-total resection of the tumor. This case demonstrates the effectiveness of resection as definitive treatment for SUNCT syndrome associated with tumoral compression of the trigeminal nerve. Early MRI studies should be considered in all patients with SUNCT, especially those with atypical signs and symptoms.

Familial SUNCT in mother and son

Cephalalgia ◽  
2016 ◽  
Vol 36 (10) ◽  
pp. 993-997 ◽  
Author(s):  
Isabel Pavão Martins ◽  
Pedro Viana ◽  
Patricia Pita Lobo
Keyword(s):  
Trigeminal Nerve ◽  
Case Reports ◽  
Heterogeneous Group ◽  
Familial Case ◽  
Trigeminal Autonomic Cephalalgias ◽  
Conjunctival Injection ◽  
Historical Account ◽  
Autonomic Symptoms ◽  
Genetic Nature

Background Trigeminal autonomic cephalalgias comprise a heterogeneous group of lateralized headaches associated with ipsilateral autonomic symptoms. They are usually localized within the territory of one or more rami of the trigeminal nerve, but may be localized outside its cutaneous territory. Although these headaches are considered primary disorders, the evidence supporting their genetic nature is lacking, particularly concerning their neuralgic forms, with the exception of a familial case described partly based on a historical account. Case reports We report on a mother and son with episodic, short-lasting, intense, paroxysmal headaches, with the same localization in the left retroauricular region, associated with prominent conjunctival injection and tearing, which are consistent with the diagnosis of SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing). Discussion These cases corroborate the existence of hereditary forms of this disorder, thus supporting its primary nature.

SUNCT/SUNA

2020 ◽  
pp. 196-202
Author(s):  
Juan A. Pareja ◽  
Leopoldine A. Wilbrink ◽  
María-Luz Cuadrado
Keyword(s):  
Deep Brain Stimulation ◽  
Trigeminal Nerve ◽  
Preventive Treatment ◽  
Gasserian Ganglion ◽  
Trigeminal Autonomic Cephalalgias ◽  
Sphenopalatine Ganglion ◽  
Conjunctival Injection ◽  
Intravenous Lidocaine ◽  
Drug Of Choice ◽  
Ablative Procedures

Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic features (SUNA) are currently classified in the section of the trigeminal autonomic cephalalgias as separate subtypes of the same disorder (short-lasting unilateral neuralgiform headache attacks). There is no therapy consistently effective for SUNCT or SUNA. During the worst periods intravenous lidocaine or phenytoin may decrease the frequency of SUNCT/SUNA attacks. Lamotrigine is the drug of choice for the preventive treatment of SUNCT, but it is less effective for SUNA. Gabapentin may be also effective for both SUNCT and SUNA. Topiramate can be effective in SUNCT, but it has not shown an effect in SUNA. Some medically refractory cases have obtained benefit from surgical procedures. These include microvascular decompression of the trigeminal nerve, ablative procedures involving the trigeminal nerve, Gasserian ganglion or sphenopalatine ganglion, occipital nerve stimulation, and hypothalamic deep brain stimulation.

Trigeminal Neuralgia with Lacrimation Or Sunct Syndrome?

Cephalalgia ◽  
1998 ◽  
Vol 18 (2) ◽  
pp. 85-90 ◽  
Author(s):  
R Benoliel ◽  
Y Sharav
Keyword(s):  
Differential Diagnosis ◽  
Trigeminal Neuralgia ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Intimate Relationship ◽  
The Other ◽  
Conjunctival Injection ◽  
Sunct Syndrome ◽  
Clinical Signs And Symptoms

An intimate relationship between trigeminal neuralgia (TN) and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) syndrome, based on similar clinical signs and symptoms and on cases demonstrating possible “transformation” from one entity to the other, has been widely accepted. We evaluated the presence of lacrimation in 22 consecutive cases that had been diagnosed as TN. Ipsilateral lacrimation was reported by 6 such cases (5M, 1F). These cases responded to antineuralgic therapy with concomitant resolution of lacrimation and were clinically very similar to TN. The differential diagnosis and the possibility of lacrimation in TN are discussed.

Vascular Malformation of the Cerebellopontine Angle Associated with “SUNCT” Syndrome

Cephalalgia ◽  
1994 ◽  
Vol 14 (4) ◽  
pp. 301-302 ◽  
Author(s):  
F Morales ◽  
E Mostacero ◽  
J Marta ◽  
S Sanchez
Keyword(s):  
Vascular Malformation ◽  
Cerebellopontine Angle ◽  
Temporal Region ◽  
Conjunctival Injection ◽  
Sunct Syndrome ◽  
Cranial Ct ◽  
The Past ◽  
Unilateral Headache ◽  
The Right ◽  
Ct And Mri

A 70-year-old man complained of two distinct types of unilateral headache during the past fifteen years. When the illness began, the pain was intermittent and short-lasting. In successive years, the crises appeared in clusters and lasted weeks to months. At present, the pain occurs daily, and is located on the right side, from the forehead supraorbitally to the temporal region. Some attacks last 30 sec and are accompanied by tearing, conjunctival injection, rhinorrhea and a subjective need to micturate. Other headaches last 1/2-1 h and are occasionally accompanied by local ipsilateral dysautonomic symptoms. Attacks of pain are provoked by movements of the trunk and neck. A vascular malformation in the right cerebellopontine angle was demonstrated on cranial CT and MRI, and by angiography.

scholarly journals Termination of SUNCT with intravenous lignocaine followed by oral mexiletine

2018 ◽  
Vol 1 ◽  
pp. 251581631876882
Author(s):  
Eoin Mulroy ◽  
Oliver Armstrong-Scott ◽  
Peter Bergin
Keyword(s):  
Side Effects ◽  
Trigeminal Nerve ◽  
Facial Pain ◽  
Trigeminal Autonomic Cephalalgias ◽  
Conjunctival Injection ◽  
Autonomic Symptoms ◽  
First Report ◽  
Successful Transition

Background: The trigeminal autonomic cephalalgias (TACs) are a group of debilitating, pathophysiologically similar headache syndromes characterized by facial pain and autonomic symptoms in areas supplied by the trigeminal nerve. Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) is among the rarest of the TAC syndromes and can be particularly recalcitrant to treatment. Case: We describe the case of a 50-year old woman with difficult-to-control SUNCT whose pain was completely aborted within hours of commencing intravenous lignocaine therapy and was maintained pain-free after transitioning to oral mexiletine. Conclusion: This is the first report of successful transition from intravenous lignocaine to oral mexiletine in SUNCT, and we suggest that this treatment should be tried early in difficult-to-control SUNCT. This therapy is safe, effective and with minimal side effects if administered in an appropriate manner.

scholarly journals Retrosigmoid Craniectomy for Resection of Epidermoid causing Trigeminal Neuralgia

2019 ◽  
Vol 80 (S 03) ◽  
pp. S320-S321 ◽  
Author(s):  
Anubhav G. Amin ◽  
John V. Wainwright ◽  
Chirag D. Gandhi ◽  
Christian A. Bowers
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Cerebellopontine Angle ◽  
Cranial Nerves ◽  
Patient Positioning ◽  
Mass Effect ◽  
Sigmoid Sinus ◽  
Total Resection ◽  
Patient Reported

The differential diagnosis for trigeminal neuralgia like-symptoms includes cerebellopontine angle lesions causing regional mass effect upon the trigeminal nerve (Fig. 1). Here we present an operative video manuscript of a patient experiencing trigeminal neuralgia, secondary to an epidermoid cyst, in which a retrosigmoid craniectomy was performed to resect the epidermoid and decompress the trigeminal nerve (Fig. 2). This video highlights the operative nuances to achieving a successful surgery, including appropriate patient positioning, dural exposure to the transverse-sigmoid sinus junction, arachnoid dissection, and decompression of cranial nerves. A gross total resection was achieved; the patient reported immediate relief of facial pain postoperatively and has been pain free at the ten month follow-up.The link to the video can be found at: https://youtu.be/Ja2eE0uGk4E.

SUNCT syndrome with paroxysmal mydriasis: Clinical and pupillometric findings

Cephalalgia ◽  
2010 ◽  
Vol 30 (8) ◽  
pp. 987-990 ◽  
Author(s):  
F Antonaci ◽  
G Sances ◽  
M Loi ◽  
G Sandrini ◽  
C Dumitrache ◽  
...  
Keyword(s):  
High Frequency ◽  
Early Onset ◽  
Signs And Symptoms ◽  
Primary Headache ◽  
Pain Severity ◽  
Conjunctival Injection ◽  
Sunct Syndrome ◽  
Different Levels

SUNCT syndrome (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing) is a primary headache characterised by a high frequency of attacks associated with marked autonomic periocular signs and symptoms. Activation of the hypothalamus via the superior salivary nucleus is probably responsible for some of the autonomic involvement observed during SUNCT attacks. We describe a case of SUNCT with unusual autonomic features (e.g., mydriasis) and early onset. Pupillometric studies were performed both in a basal condition (without anisocoria) and after instillation of phenylephrine (a drug with direct sympathomimetic activity) and pilocarpine (a parasympathetic agonist). The findings in this patient seem to indicate involvement of the ocular sympathetic supply in SUNCT, responsible for the mydriasis, and seem to strengthen the possibility that the autonomic phenomena in this syndrome vary with different levels of pain severity.

Meningiomas Of the Internal Auditory Canal

Neurosurgery ◽  
2004 ◽  
Vol 55 (1) ◽  
pp. 119-128 ◽  
Author(s):  
Makoto Nakamura ◽  
Florian Roser ◽  
Sharham Mirzai ◽  
Cordula Matthies ◽  
Peter Vorkapic ◽  
...  
Keyword(s):  
Cerebellopontine Angle ◽  
Clinical Symptoms ◽  
Management Strategies ◽  
Internal Auditory Canal ◽  
Signs And Symptoms ◽  
Vestibular Schwannomas ◽  
Additional Patient ◽  
Surgical Removal ◽  
Neurosurgical Department ◽  
Vestibulocochlear Nerve

Abstract OBJECTIVE: Meningiomas arising primarily within the internal auditory canal (IAC) are notably rare. By far the most common tumors that are encountered in this region are neuromas. We report a series of eight patients with meningiomas of the IAC, analyzing the clinical presentations, surgical management strategies, and clinical outcomes. METHODS: The charts of the patients, including histories and audiograms, imaging studies, surgical records, discharge letters, histological records, and follow-up records, were reviewed. RESULTS: One thousand eight hundred meningiomas were operated on between 1978 and 2002 at the Neurosurgical Department of Nordstadt Hospital. Among them, there were 421 cerebellopontine angle meningiomas; 7 of these (1.7% of cerebellopontine angle meningiomas) were limited to the IAC. One additional patient underwent surgery at the Neurosurgical Department of the International Neuroscience Institute, where a total of 21 cerebellopontine angle meningiomas were treated surgically from 2001 to 2003. As a comparison, the incidence of intrameatal vestibular schwannomas during the same period, 1978 to 2002, was 168 of 2400 (7%). There were five women and three men, and the mean age was 49.3 years (range, 27–59 yr). Most patients had signs and symptoms of vestibulocochlear nerve disturbance at presentation. One patient had sought treatment previously for total hearing loss before surgery. No patient had a facial paresis at presentation. The neuroradiological workup revealed a homogeneously contrast-enhancing tumor on magnetic resonance imaging in all patients with hypointense or isointense signal intensity on T1- and T2-weighted images. Some intrameatal meningiomas showed broad attachment, and some showed a dural tail at the porus. In all patients, the tumor was removed through the lateral suboccipital retrosigmoid approach with drilling of the posterior wall of the IAC. Total removal was achieved in all cases. Severe infiltration of the facial and vestibulocochlear nerve was encountered in two patients. There was no operative mortality. Hearing was preserved in five of seven patients; one patient was deaf before surgery. Postoperative facial weakness was encountered temporarily in one patient. CONCLUSION: Although intrameatal meningiomas are quite rare, they must be considered in the differential diagnosis of intrameatal mass lesions. The clinical symptoms are very similar to those of vestibular schwannomas. A radiological differentiation from vestibular schwannomas is not always possible. Surgical removal of intrameatal meningiomas should aim at wide excision, including involved dura and bone, to prevent recurrences. The variation in the anatomy of the faciocochlear nerve bundle in relation to the tumor has to be kept in mind, and preservation of these structures should be the goal in every case.

TAMI-01. BRAIN METASTASES: CURRENT LITERATURE REVIEW

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi198-vi198
Author(s):  
Ruchi Raval ◽  
Aadi Pandya ◽  
Jaspreet Behl ◽  
Sumul Raval
Keyword(s):  
Literature Review ◽  
Brain Metastases ◽  
Current Literature ◽  
Anticoagulation Therapy ◽  
Signs And Symptoms ◽  
The Body ◽  
Definitive Treatment ◽  
Cognitive Changes ◽  
Cancer Breast ◽  
The Brain

Abstract PURPOSE As more information is gathered about brain metastases, it still remains that the current prognosis of brain metastases is very poor. Due to this, it is imperative that physicians are aware of the most important components regarding brain metastases. This literature review will encompass the most current literature in order to highlight the most crucial information. METHODS All mentioned studies and literature reviews cited in the paper were obtained through various sites, and were published between 1996 and 2017. The main components that were required from the papers reviewed included where in the body the brain metastases originated from, where in the brain they tended to spread to, what the signs and symptoms typical of patients with brain metastases are, and what the options are in terms of treatment. RESULTS Using the results from a variety of studies performed within the past three decades, it is apparent that brain metastases most commonly originate from, in order of increasing frequency, lung cancer, breast cancer, melanoma, and colorectal cancer. In addition, it is reaffirmed that the magnetic resonance imaging (MRI) is the best diagnostic tool to be used when dealing with brain metastases. The most frequent signs and symptoms of a brain metastases include cognitive changes, headaches, weakness, and seizures. Finally, supportive treatment includes use of corticosteroids, antiepileptic drugs (AEDs), and anticoagulation therapy. Definitive treatment for brain metastases varies based on size, location, and prevalence in the brain, but the most effective options include chemotherapy, radiation therapy, and surgery. CONCLUSIONS The study’s results confirm the need for more research to be done regarding brain metastases, and better options to increase the survival of patients.

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