Secondary SUNCT Research Articles

Secondary SUNCT Syndrome with Transformation from Trigeminal Neuralgia.

Secondary SUNCT Syndrome with Transformation from Trigeminal Neuralgia.

Secondary SUNCT Syndrome in a Patient with Rathke’s Cleft Cyst and Hyperprolactinemia: a Case Report

Pathophysiology of short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) remains unclear. SUNCT is considered the primary type of a headache, but several cases of secondary SUNCT syndrome were described in patients with pituitary neoplasms, mainly pituitary micro- and macroadenomas. Rathke’s cleft cyst is a suprasellar noncancerous cystic lesion. We described a new case of SUNCT in a patient with Rathke’s cleft cyst with persistent hyperprolactinemia at the beginning of the headaches. After beginning of treatment with antiepileptic drugs (topiramate 75 mg/day, followed by replacement lamotrigine 75 mg/day), the headaches regressed. Also, cabergoline 0.5 mg was added to the therapy, 1 time a week; after 4 months, the level of prolactin was normalized, after beginning of dopamine agonists. After discontinuation of all treatments, after 4 months, the patient again began to develop daily single headaches, clinically similar to those that were at the onset of the disease, against the background of an increase in blood prolactin levels. Against the background of normalization of prolactin level, the headaches disappeared. We assume that in this case, the main reason for the secondary SUNCT was an influence of anatomical structures and caused neuroendocrine changes in the hypothalamus-pituitary system, but there are still discussions about what mechanism is the main reason for SUNCT. Therefore, clinicians should also pay attention to the history of symptoms associated with tumors in the pituitary gland and perform magnetic resonance imaging of the brain, pituitary gland, and screening for hormonal disorders in the blood serum.

SUNCT and SUNA: an Update and Review.

The purpose of this review is to provide an update on the clinical features, diagnosis, pathogenesis, epidemiology, and treatment of the rare primary headache disorders short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with autonomic symptoms (SUNA). Together these entities are known as short-lasting unilateral neuralgiform headache attacks (SUNHA). Recent case reports of secondary SUNCT and SUNA due to medullary infarcts support the theory that the trigeminohypothalamic pathway is involved in the pathophysiology of SUNHA. While medical therapy for SUNHA has not significantly changed, surgical therapy for refractory SUNCT and SUNA has made advancements with a recent case series demonstrating the efficacy of deep brain stimulation. We will discuss the pathophysiology of both the pain and the autonomic symptoms experienced in SUNCT and SUNA attacks as well the medical, procedural, and surgical options for treatment with emphasis on recent advances. Specific secondary causes reported in the recent literature will be discussed in brief.

Secondary Short-Lasting Unilateral Neuralgiform Headache with Conjunctival Injection and Tearing: A New Case and a Literature Review.

Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) is a primary headache syndrome with an unclear pathogenesis. However, there is increasing evidence in the literature for secondary SUNCT being attributable to certain known lesions. We explored the possible neurobiological mechanism underlying SUNCT based on all reported cases of secondary SUNCT for which detailed information is available. Here we report a case of neuromyelitis optica spectrum disorders that had typical symptoms of SUNCT that might have been attributable to involvement of the spinal nucleus of the trigeminal nerve. We also review cases of secondary SUNCT reported in the English-language literature and analyze them for demographic characteristics, clinical features, response to treatment, and imaging findings. The literature review shows that secondary SUNCT can derive from a neoplasm, vascular disease, trauma, infection, inflammation, or congenital malformation. The pons with involvement of the trigeminal root entry zone was the most commonly affected region for inducing secondary SUNCT. In conclusion, the neurobiology of secondary SUNCT includes structures such as the nucleus and the trigeminal nerve with its branches, suggesting that some cases of primary SUNCT have underlying mechanisms that are related to existing focal damage that cannot be visualized.

Secondary Sunct syndrome related to right pterygopalatine fossa and maxillary sinus nerve sheath tumour

Background: Short-lasting Unilateral Neuralgiform headache with Conjunctival injection and Tearing (SUNCT) syndrome is a rare Primary headache disorder and is classified under the category of Trigeminal Autonomic Cephalalgias.

Secondary SUNCT syndrome caused by viral meningitis

A 49-year-old male had been complaining of general fatigue since July 31, 2007. On August 3, he developed a headache in the forehead bilaterally, and he had a slight fever on the next day. At 3:00 a.m. on August 3, a stabbing pain lasting less than 3 seconds suddenly occurred on the right side of the forehead, cheek, and jaw. He felt pain while he was awake. The pain attacks occurred at least once every two or three minutes, and at most once every 10 seconds; attacks occurred with a frequency from 100 to 200 times per day. During the attacks, he showed dacryorrhea, swelling of the eyelids of the right eye, and rhinorrhea. The patient was not able to keep still because of his severe, stabbing headache. During the daytime of August 6, the pain moved to the right occipital and right upper auricular regions. The symptoms persisted, and he was admitted on August 7. His past history and family history were not contributory. The patient reported a stabbing headache in the right side of the forehead, cheek, and jaw, as well as in the upper auricular and occipital regions. On physical examination, Yasuo Ito Toshimasa Yamamoto Mikiko Ninomiya Yoshikazu Mizoi Kaori Itokawa Naotoshi Tamura Nobuo Araki Kunio Shimazu

SUNCT syndrome: report of a possible symptomatic case

SUNCT is one of the rarest and least known primary headache disorders. Although its pathogenesis has been partially understood by functional neuroimaging and reports of secondary cases, there is limited understanding of its cause. We report a case of SUNCT in a 54-years-old man, that could not be strictly classified as secondary SUNCT; however, the time lag of pain onset suggests a new theory in which neuroplasticity could be involved in the origin and duration of the pain in SUNCT syndrome.

Secondary SUNCT Syndrome to a Variant of the Vertebrobasilar Vascular Development

Secondary SUNCT Syndrome to a Variant of the Vertebrobasilar Vascular Development

Secondary SUNCT Due to Intraorbital, Metastatic Bronchial Carcinoid

Secondary SUNCT Due to Intraorbital, Metastatic Bronchial Carcinoid

A Case of SUNCT Syndrome Responsive to Verapamil

SUNCT is a rare headache disorder, first described by Sjaastad et al. in 1989 (1) and recently codified by the International Classification of Headache Disorders as a primary headache (2). The literature, however, discloses some cases of secondary SUNCT syndrome, particularly due to lesions in the posterior fossa or involving the pituitary gland (3–10). The pharmacological treatment of this syndrome is problematic. Some encouraging results have been recently suggested with lamotrigine (11–15), gabapentin (16, 17) and topiramate (18, 19); all previous attempts at treatment with drugs used for other short-lasting headaches were unsuccessful (20). It is noteworthy that two reports (21, 22) even reported a worsening effect of verapamil in patients affected by SUNCT. We describe a patient with SUNCT syndrome and an ischaemic lesion in the posterior fossa, who was successfully treated with verapamil.