Sprenger T, Valet M, Hammes M, Erhard P, Berthele A, Conrad B, Tolle T R
Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
Cephalalgia. 2004 Sep;24(9):753-7. doi: 10.1111/j.1468-2982.2004.00753.x.
We report headache induced BOLD changes in an atypical case of trigeminal autonomic cephalgia (TAC). A 68-year-old patient was imaged using fMRI during three attacks of a periorbital head-pain with a average duration of 3 min. During the attacks, left sided conjunctival injection, rhinorrhea, lacrimation, facial sweating and hypersalivation were apparent. These attacks were usually partly responsive to oxygen administration but otherwise refractory to any drug. The patient described either attacks with a duration of one minute or less or longer attacks persisting for maximum of 20 min with headaches occurring up to 100 times a day. When considering the symptoms, frequency, duration and therapeutic response of the patient's headache, no clear-cut classification to one of the subtypes of trigeminal autonomic cephalgias (cluster headache, paroxysmal hemicrania, SUNCT) or trigeminal neuralgia was possible. The cerebral activation pattern was similar but not identical to those previously observed in cluster headache and SUNCT with a prominent activation in the hypothalamic grey matter. This case study underlines the conceptual value of the term TAC for the group of headaches focusing around the trigeminal-autonomic reflex. Our results emphasize the importance of the hypothalamus as key region in the pathophysiology of this entity.
我们报告了一例非典型三叉自主神经性头痛（TAC）中头痛诱发的脑血氧水平依赖性功能磁共振成像（BOLD）变化。一名68岁患者在三次眶周头痛发作期间接受了功能磁共振成像检查，每次发作平均持续3分钟。发作期间，左侧结膜充血、流涕、流泪、面部出汗和流涎明显。这些发作通常对吸氧有部分反应，但对任何药物均难治。患者描述发作持续时间为1分钟或更短，或较长发作持续最长20分钟，每天头痛发作多达100次。考虑到患者头痛的症状、频率、持续时间和治疗反应，无法明确归类为三叉自主神经性头痛的亚型（丛集性头痛、发作性偏侧头痛、短程单侧神经痛性头痛发作综合征）或三叉神经痛。脑激活模式与先前在丛集性头痛和短程单侧神经痛性头痛发作综合征中观察到的相似但不完全相同，下丘脑灰质有明显激活。本病例研究强调了TAC这一术语对于围绕三叉神经自主反射的头痛组的概念价值。我们的结果强调了下丘脑作为该疾病病理生理学关键区域的重要性。
