Lambru Giorgio, Trimboli Michele, Tan S Veronica, Al-Kaisy Adnan
1 The Headache Centre, The Pain Management and Neuromodulation Department, Guy's and St Thomas' NHS Foundation Trust, London, UK.
2 Department of Neurology and Neurophysiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Cephalalgia. 2017 Apr;37(5):486-490. doi: 10.1177/0333102416652093. Epub 2016 May 24.
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.
伴有结膜充血和流泪的短暂性单侧神经痛样头痛发作（SUNCT）或伴有自主神经症状的发作（SUNA），被归为三叉自主神经性头痛（TACs）。然而，SUNCT和SUNA的表型及治疗与三叉神经痛（TN）存在重叠。此外，据报道，多种脑部病变能够引发类似TN或SUNCT的疼痛，并且新出现的结构神经影像学研究结果表明，神经血管与三叉神经的冲突在SUNCT中可能发挥作用，这进一步支持了SUNCT、SUNA和TN在病因学和病理生理学上的重叠。病例报告：我们报告了首例因延髓背外侧出血性梗死导致慢性SUNCT样和TN样表型共存的病例。讨论：鉴于我们的病例，延髓背外侧回路的紊乱可能构成一个重要的病理生理成分，支持了一种统一的疾病分类学假设，即认为SUNCT、SUNA和TN是同一疾病的临床变体。
