title: SUNCT: bilateral hypothalamic activation during headache attacks and resolving of symptoms after trigeminal decompression.
abstract: Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) is a primary head-pain syndrome, which is often refractory to any medical treatment. Concerning the pathophysiology of SUNCT, hypothalamic involvement ipsilaterally to the pain has been suggested based on the clinical features and one functional imaging case report. Here we now report a new case with SUNCT and the concomitant cerebral activation pattern (fMRI) during the pain attacks. In addition to an activation of several brain structures known to be generally involved in pain processing, bilateral hypothalamic activation occurred during the pain attacks, arguing for a central origin of the headache. Interestingly, this patient became completely pain free after surgical decompression of the ipsilateral trigeminal nerve. We hypothesize that in this case with a central predisposition for trigeminal autonomic cephalgias, a peripheral trigger with ectopic excitation might have contributed to the clinical picture of SUNCT.
authors.affiliation: Department of Neurology, Technische Universität München, Klinikum rechts der Isar, Moehlstr 28, D-81675 Munich, Germany Neurologische Gemeinschaftspraxis, Leopoldstr. 59, 80802 Munich, Germany Department of Neurosurgery, Ludwig Maximillians Universität, Klinikum Grosshadern, Munich, Germany.
authors.forename: Till
authors.initials: T
authors.lastname: Sprenger
authors.forename: Michael
authors.initials: M
authors.lastname: Valet
authors.forename: Stefan
authors.initials: S
authors.lastname: Platzer
authors.forename: Volker
authors.initials: V
authors.lastname: Pfaffenrath
authors.forename: Ulrich
authors.initials: U
authors.lastname: Steude
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Tolle
mesh_terms: D001808:Blood Vessels / Q000473:pathology; D003229:Conjunctival Diseases / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D007839:Functional Laterality; D006801:Humans; D007031:Hypothalamus / Q000098:blood supply / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D014276:Trigeminal Nerve / Q000601:surgery*; D014653:Vascular Headaches / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*
chemical_list: D010100:Oxygen