title: Cluster-like headache and a cystic hypothalamic tumour as first presentation of sarcoidosis.
abstract: BACKGROUND
  Sarcoidosis is a granulomatous, multisystem inflammatory disease of unknown cause, which presents with a wide variety of symptoms. We describe a rare case of a newly diagnosed sarcoidosis, with cluster-like headache as a presenting symptom.
  
  
  METHODS
  A 31-year-old man presented with cluster headache with a cystic lesion in the hypothalamus. A non-caseating granuloma consistent with the diagnosis sarcoidosis was found at biopsy. Pulmonary involvement was confirmed on positron electron tomography-computed tomography (PET-CT). Treatment with prednisone led to regression of the hypothalamic lesion. Headache attacks did not recur.
  
  
  CONCLUSIONS
  Cluster-like headache with a cystic hypothalamic lesion as first presentation of sarcoidosis has never been reported. Their possible relationship seems to underline the role of the hypothalamus in the central pain-regulatory areas in the brain, but is not undisputed. This case clearly demonstrates once again the relevance of neuroimaging in new-onset cluster-like headache.
authors: Department of Neurosurgery, Slotervaartziekenhuis, 1066 EC Amsterdam, Netherlands. stevenvandervlist@gmail.com
authors: Steven H M
authors: SH
authors: van der Vlist
authors: Bernard J C M
authors: BJ
authors: Hummelink
authors: Johan
authors: J
authors: Westerga
authors: Willem
authors: W
authors: Boogerd
mesh_terms: D000328:Adult; D001927:Brain Diseases / Q000209:etiology* / Q000473:pathology; D003027:Cluster Headache / Q000209:etiology*; D003560:Cysts / Q000473:pathology; D006099:Granuloma / Q000209:etiology / Q000473:pathology; D006801:Humans; D007031:Hypothalamus / Q000473:pathology*; D008297:Male; D012507:Sarcoidosis / Q000150:complications* / Q000473:pathology*