SUNCT: bilateral hypothalamic activation during headache attacks and resolving of symptoms after trigeminal decompression
SUNCT: bilateral hypothalamic activation during headache attacks and resolving of symptoms after trigeminal decompression
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DOI：
10.1016/j.pain.2004.09.021
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发表时间：
2005-02-01
期刊：
影响因子：
7.4
通讯作者：
Tolle, TR
中科院分区：
文献类型：
--
作者：
Sprenger, T;Valet, M;Tolle, TR
短暂的单侧神经性头痛伴结膜注射和撕裂(SUNCT)是一种主要的头痛综合征，通常对任何药物治疗都难以奏效。关于SUNCT的病理生理学，根据临床特征和一例功能成像病例报告，提示下丘脑受累于同侧疼痛。在这里，我们现在报告一例新的SUNCT和伴随的大脑激活模式(FMRI)在疼痛发作期间。除了已知的几个通常参与疼痛处理的大脑结构的激活外，双侧下丘脑在疼痛发作期间也被激活，这证明了头痛的中心起源。有趣的是，这位患者在同侧三叉神经手术减压后完全没有疼痛。我们推测，在这个三叉神经性自主神经头痛的中枢性易感病例中，异位兴奋的外周触发可能与SUNCT的临床表现有关。(C)2004年国际疼痛研究协会。爱思唯尔出版，版权所有。
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. (C) 2004 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.