Departments of Neurology and Algology.
Radiology, Gazi University Faculty of Medicine, Ankara, Turkey.
Pain Med. 2017 Jul 1;18(7):1377-1381. doi: 10.1093/pm/pnw334.
Short-lasting unilateral neuralgiform headache attack with conjunctival injection and tearing (SUNCT) is one of the trigeminal autonomic cephalalgias where neurovascular compression was detected in neuroimaging in recent years.
We report two cases, a 52-year-old adult and a 69-year-old elderly patient with short-lasting and recurrent headache combined with cranial autonomic features. Diffusion tensor imaging (DTI) and magnetic resonance (MR) tractography of both patients outlined structural changes of the trigeminal nerve revealing neurovascular compression. Pain and autonomic symptoms were completely relieved in the 52-year-old patient who underwent microvascular decompression surgery.
To our knowledge, this is the first time in the literature where MR tractography revealed structural changes in the trigeminal nerve secondary to neurovascular compression in SUNCT patients. We suggest that in SUNCT patients high-resolution magnetic resonance imaging (MRI) and/or DTI-MR tractography should be performed to exclude neurovascular compression. We propose that the compression of the trigeminal nerve could generate SUNCT symptoms and the posterior hypothalamus could be activated secondarily. With this point of view, trigeminal neuralgia and SUNCT could represent the different features of the neurovascular compression spectrum.
短发性单侧头痛发作伴结膜充血和流泪（SUNCT）是三叉神经自主神经性头痛的一种，近年来神经影像学检查发现其存在神经血管压迫。
我们报告了两例病例，一例为 52 岁成年患者，另一例为 69 岁老年患者，均表现为短暂、反复发作的头痛合并颅自主神经症状。两位患者的弥散张量成像（DTI）和磁共振（MR）追踪均显示出三叉神经的结构变化，存在神经血管压迫。52 岁患者接受微血管减压手术后疼痛和自主神经症状完全缓解。
据我们所知，这是首次在文献中报道 SUNCT 患者的 MR 追踪显示神经血管压迫导致三叉神经结构变化。我们建议对 SUNCT 患者行高分辨率磁共振成像（MRI）和/或 DTI-MR 追踪，以排除神经血管压迫。我们提出三叉神经受压可能会产生 SUNCT 症状，而后下丘脑可能会继发激活。从这个角度来看，三叉神经痛和 SUNCT 可能代表了神经血管压迫谱的不同特征。
