Lagares Alfonso, Gómez Pedro A, Pérez-Nuñez Angel, Lobato Ramiro D, Ramos Ana
Department of Neurosurgery, Hospital 12 de Octubre, Madrid, Spain.
Neurosurgery. 2005 Feb;56(2):E413; discussion E413. doi: 10.1227/01.neu.0000147981.90703.8f.
Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing syndrome is a very rare disorder characterized by short-lasting neuralgiform unilateral pain affecting the orbital-periorbital area and associated with autonomic phenomena consisting mainly of conjunctival injection, tearing, and rhinorrhea. Treatment of this condition is difficult; many drugs and surgical procedures have been tried with variable results. In the literature, two cases have been described with short-term response to microvascular decompression of the trigeminal root. We present the case of a patient with short-lasting unilateral neuralgiform headache with conjunctival injection and tearing syndrome who remains asymptomatic 2 years after microvascular decompression.
A 56-year-old woman was referred to our clinic because she had experienced pain in the distribution of the first left trigeminal branch during the previous 2 years. She experienced paroxysms lasting from a few seconds to 1 to 2 minutes superimposed over a dull sensation of pain involving the same territory. The paroxysms had no refractory period and were triggered by touching the eye or the left side of the face, chewing, yawning, washing her hair, and even by light. Although the paroxysms were triggered by light touch or chewing, she was able to talk or touch herself while having the paroxysm. During pain attacks, she experienced tearing and ipsilateral conjunctival injection, eyelid edema and rhinorrhea, as well as intense photophobia. A magnetic resonance imaging scan revealed a vascular structure distorting and compressing the trigeminal root.
The patient underwent microvascular decompression of the trigeminal root. At surgery, there was clear compression of the trigeminal root by a superior cerebellar artery loop that was resolved by interposing a Teflon patch. The patient awoke from the operation without pain, and all the accompanying signs and symptoms, such as photophobia, disappeared. The postoperative course was uneventful, and 2 years after treatment, the patient remains asymptomatic.
Microvascular decompression could be an alternative therapeutic approach to this rare syndrome.
短暂性单侧神经痛性头痛伴结膜充血及流泪综合征是一种非常罕见的疾病，其特征为短暂性单侧神经痛样疼痛，累及眼眶 - 眶周区域，并伴有主要由结膜充血、流泪和流涕组成的自主神经现象。这种疾病的治疗很困难；许多药物和外科手术都曾尝试过，但结果各异。在文献中，有两例描述了对三叉神经根微血管减压术有短期反应的病例。我们报告一例短暂性单侧神经痛性头痛伴结膜充血及流泪综合征患者，在微血管减压术后2年仍无症状。
一名56岁女性因在前两年中左侧三叉神经第一支分布区域出现疼痛而被转诊至我们的诊所。她经历了持续数秒至1 - 2分钟的阵发性疼痛，叠加在涉及相同区域的钝痛感觉之上。这些阵发性疼痛没有不应期，可由触摸眼睛或左侧面部、咀嚼、打哈欠、洗头甚至光线触发。尽管阵发性疼痛由轻触或咀嚼触发，但她在发作时仍能说话或触摸自己。在疼痛发作期间，她经历了流泪、同侧结膜充血、眼睑水肿和流涕，以及强烈的畏光。磁共振成像扫描显示一个血管结构扭曲并压迫三叉神经根。
患者接受了三叉神经根微血管减压术。手术中，小脑上动脉袢明显压迫三叉神经根，通过置入一块特氟龙补片得以解除压迫。患者术后醒来时无疼痛，所有伴随的体征和症状，如畏光，均消失。术后过程平稳，治疗后2年患者仍无症状。
微血管减压术可能是这种罕见综合征的一种替代治疗方法。
