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NEUROLOGY 2009;72:e37
© 2009 American Academy of Neurology
Resident and Fellow Section

Video NeuroImage: Symptomatic SUNCT syndrome cured after trigeminal neurovascular contact surgical decompression

Formula

R. Guerreiro, MD, M. Casimiro, MD, D. Lopes, MD, J. Pinto Marques, MD and P. Fontoura, MD, PhD

From the Neurology Department (R.G., D.L., J.P.M., P.F.), Hospital São Bernardo, Setúbal; Neurosurgery Department (M.C.), Hospital Egas Moniz, Lisbon; and Department of Immunology (P.F.), Faculty of Medical Sciences, New University of Lisbon, Portugal.

Address correspondence and reprint requests to Prof. Paulo Fontoura, Department of Immunology, Faculty of Medical Sciences, New University of Lisbon, Campo dos Mártires da Pátria, no. 130, 1169-056 Lisbon, Portugal paulo.fontoura{at}fcm.unl.pt

Short lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) syndrome is a rare trigemino-autonomic cephalalgia characterized by unilateral, periorbital, neuralgiform attacks of short duration accompanied by prominent autonomic dysfunction. Treatment of SUNCT can be challenging and is often ineffective.

A 57-year-old man had a 3-month history of intense left periorbital pain, ipsilateral conjunctival injection, and tearing, occurring 5–10/hour and lasting 30–120 seconds (video), refractory to several medications. Attacks could occur spontaneously or be provoked by mouth movements during talking or chewing. Brain MRI revealed left trigeminal nerve compression (figure, A). Microvascular decompression separated an aberrant loop of the superior cerebellar artery from first division of the trigeminal nerve root (figure, B). The patient has remained asymptomatic off medication since.


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  		Figure Compression of the left trigeminal nerve by neurovascular contact, relieved by surgical decompression

(A) 1.5 Tesla brain MRI showing left trigeminal nerve neurovascular contact (gray arrow). (B) Surgical decompression of a superior cerebellar artery aberrant loop (white arrow); a = trigeminal sensory root; b = superior cerebellar artery; c = trigeminal vein; d = trigeminal motor root.

 

SUNCT bears several similarities with first division trigeminal neuralgia, but unlike trigeminal neuralgia, symptomatic cases usually appear with posterior fossa and diencephalic lesions.1 In our patient, typical attacks were found in relation to first division trigeminal nerve compression. In such cases, surgical decompression may provide complete resolution of symptoms.2

Supplemental data at www.neurology.org

Disclosure: The authors report no disclosures.


   REFERENCES
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 REFERENCES
 

  1. Favier I, van Vliet JA, Roon KI, et al. Trigeminal autonomic cephalgias due to structural lesions: a review of 31 cases. Arch Neurol 2007;64:25–31.[Abstract/Free Full Text]
  2. Köseoglu E, Karaman Y, Kücük S, Arman F. SUNCT syndrome associated with compression of the trigeminal nerve. Cephalalgia 2005;25:473–475.[Medline]




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