MR Tractography in Short Lasting Unilateral Neuralgiform Headache Attacks with Conjunctival Injection and Tearing (SUNCT) Patients: Case Reports.
BACKGROUND
Short-lasting unilateral neuralgiform headache attack with conjunctival injection and tearing (SUNCT) is one of the trigeminal autonomic cephalalgias where neurovascular compression was detected in neuroimaging in recent years.


METHODS
We report two cases, a 52-year-old adult and a 69-year-old elderly patient with short-lasting and recurrent headache combined with cranial autonomic features. Diffusion tensor imaging (DTI) and magnetic resonance (MR) tractography of both patients outlined structural changes of the trigeminal nerve revealing neurovascular compression. Pain and autonomic symptoms were completely relieved in the 52-year-old patient who underwent microvascular decompression surgery.


CONCLUSIONS
To our knowledge, this is the first time in the literature where MR tractography revealed structural changes in the trigeminal nerve secondary to neurovascular compression in SUNCT patients. We suggest that in SUNCT patients high-resolution magnetic resonance imaging (MRI) and/or DTI-MR tractography should be performed to exclude neurovascular compression. We propose that the compression of the trigeminal nerve could generate SUNCT symptoms and the posterior hypothalamus could be activated secondarily. With this point of view, trigeminal neuralgia and SUNCT could represent the different features of the neurovascular compression spectrum.
Departments of Neurology and Algology.
Ozlem
O
Coskun
Radiology, Gazi University Faculty of Medicine, Ankara, Turkey.
Murat
M
Ucar
Departments of Neurology and Algology.
Doga
D
Vuralli
Department of Algology, Tepecik Training and Research Hospital, Izmir, Turkey.
Funuzar
F
Yildirim
Department of Neurology, Gazi University Faculty of Medicine, Ankara, Turkey.
Rumeysa
R
Cetinkaya
Department of Anesthesiology and Reanimation and Algology, Ankara Training and Research Hospital, Ankara, Turkey.
Suna
S
Akin Takmaz
Department of Neurology, Istanbul Okmeydani Training and Research Hospital, Istanbul, Turkey.
Serap
S
Ucler
D000368:Aged; D003027:Cluster Headache / Q000150:complications / Q000000981:diagnostic imaging*; D003228:Conjunctiva; D056324:Diffusion Tensor Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D013666:Tears; D014277:Trigeminal Neuralgia / Q000150:complications / Q000000981:diagnostic imaging*
Neurovascular Compression; Surgery; Trigeminal Autonomic Cephalalgias; Trigeminal Nerve;  SUNCT