Micieli G, Magri M, Sandrini G, Tassorelli C, Nappi G
Dept. of Neurology, C Mondino Foundation, University of Pavia, Italy.
Cephalalgia. 1988 Sep;8(3):193-201. doi: 10.1046/j.1468-2982.1988.0803193.x.
In this study the variations in pupil diameter induced by different stimuli (dark-light adaptation, light reflex, electric stimulation of the sural nerve) were investigated in episodic (in the active or remission phases) and in chronic cluster headache (CH) patients. Pupil size monitoring was performed with a monocular, infrared TV pupillometer, and sural nerve stimuli were applied after the pain threshold had been measured as the flexion reflex threshold of the biceps femoris muscle (RIII reflex). The results were compared with those obtained in patients with "peripheral" (third neuron) Horner's syndrome and in healthy sex- and age-matched controls. On the symptomatic side we found an impairment of pupil response to light flashes and nociceptive stimuli; similar findings were sometimes evident on the pain-free side, too. These results substantiate previous observations that in cluster headache a dysfunction of the integrative central nervous system pathways also exists intercritically and mostly bilaterally, involving both autonomic regulation and pain perception mechanisms.
在本研究中，我们对发作性（活动期或缓解期）和慢性丛集性头痛（CH）患者在不同刺激（暗光适应、光反射、腓肠神经电刺激）下诱发的瞳孔直径变化进行了研究。使用单眼红外电视瞳孔计进行瞳孔大小监测，并在将疼痛阈值测量为股二头肌的屈曲反射阈值（RIII反射）后施加腓肠神经刺激。将结果与“外周”（第三神经元）霍纳综合征患者以及年龄和性别匹配的健康对照者的结果进行比较。在有症状的一侧，我们发现瞳孔对闪光和伤害性刺激的反应受损；在无痛侧有时也有类似发现。这些结果证实了先前的观察结果，即在丛集性头痛中，整合性中枢神经系统通路的功能障碍在发作间期也存在，且大多为双侧性，涉及自主调节和疼痛感知机制。
