title: Medullary infarction causing coexistent SUNCT and trigeminal neuralgia.
abstract: Background Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) or with autonomic symptoms (SUNA) are grouped together within the trigeminal autonomic cephalalgias (TACs). However, the SUNCT and SUNA phenotype and management overlap with those of trigeminal neuralgia (TN). Additionally, a broad variety of cerebral pathologies are reportedly able to trigger either TN- or SUNCT-like pain, and emerging structural neuroimaging findings suggest the possible role of neurovascular conflict with the trigeminal nerve in SUNCT, further supporting aetiological and pathophysiological overlaps among SUNCT, SUNA and TN. Case report We present the first case of coexisting chronic SUNCT- and TN-like phenotypes caused by haemorrhagic infarct of the dorsolateral medulla. Discussion In light of our case, a perturbation of the dorsolateral medullary circuits may constitute an important pathophysiological component, supporting a unifying nosological hypothesis that considers SUNCT, SUNA and TN clinical variants of the same disorder.
authors.affiliation: 1 The Headache Centre, The Pain Management and Neuromodulation Department, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Lambru
authors.affiliation: 1 The Headache Centre, The Pain Management and Neuromodulation Department, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Michele
authors.initials: M
authors.lastname: Trimboli
authors.affiliation: 2 Department of Neurology and Neurophysiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: S Veronica
authors.initials: SV
authors.lastname: Tan
authors.affiliation: 1 The Headache Centre, The Pain Management and Neuromodulation Department, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Adnan
authors.initials: A
authors.lastname: Al-Kaisy
mesh_terms: D002544:Cerebral Infarction / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008526:Medulla Oblongata / Q000098:blood supply / Q000000981:diagnostic imaging*; D008875:Middle Aged; D050798:SUNCT Syndrome / Q000000981:diagnostic imaging* / Q000209:etiology; D014277:Trigeminal Neuralgia / Q000000981:diagnostic imaging* / Q000209:etiology
keywords: SUNA; SUNCT; Secondary headache disorders; trigeminal autonomic cephalalgias; trigeminal neuralgia; trigeminal nucleus caudalis