Neurovascular Headache and Occipital Neuralgia Secondary to Bleeding of Bulbocervical Cavernoma

Abstract

It has recently been suggested that the trigeminocervical complex plays a crucial role in the pathophysiology of neck discomfort that accompanies migraine attacks. Clinical and neurophysiological data have shown that pain within the occipital area may be transmitted by the first trigeminal branch, which supports an anatomical and functional link between cervical and trigeminal modulation of peripheral afferents. We describe a patient with an acute symptomatic migraine attack and chronic occipital neuralgia, both due to bleeding of a bulbocervical cavernoma. The clinical presentation is also discussed and related to recent scientific data on the role of the trigeminocervical complex in both the clinical picture and underlying pathophysiological mechanisms of cervical and head pain.

Greater Occipital Nerve Neuralgia Caused by Pathological Arterial Contact: Treatment by Surgical Decompression

“…These include cervical (rheumatoid) arthritis, degenerative C1-C2 arthrosis, trauma in whiplash injury, prior skull base surgery, myelitis, bleeding from a bulbocervical cavernoma or cervicomedullary dural arteriovenous fistula, Schwannoma of the craniocervical junction or the GON, compression of the cervical roots by an anomalous ecstatic vertebral artery, or an atypically low root of the posterior inferior cerebellar artery, infections, tumors, and metabolic disorders such as diabetes and gout. [6][7][8][9][10][11][12][13] Diagnosis can be confirmed by relief of the neuralgic pain syndrome after blocking the associated nerve with infiltration of local anesthetics. 2…”

Infiltrative cervical lesions causing symptomatic occipital neuralgia

“…Case 1 had typical clinical features of ON, but Case 2 showed frontal radiation of sensory disturbances and pain, characteristic that has been previously reported in two cases of bulbocervical cavernoma and was attributed to central connections between the posterior fossa branches of C2 and the tentorial branches of the ophthalmic division of the trigeminal nerve (10,18). First trigeminal division pain and sensory disturbances appearing in Case 2 may be explained by the central connections between the descending spinal tract of the trigeminal nucleus with the injured C2-C3 afferent fibres on second-order neurons in the upper three segments of the spinal cord (26).…”

Familial neuralgia of occipital and intermedius nerves in a Chinese family

“…Our index patient and his third daughter fully fulfilled the current IHS criteria for ON, and two other family members fulfilled the current IHS criteria for ON except one criterion; namely, a decrease in pain by anesthetic block. Most ONs are idiopathic, but in rare cases, they may be a result of cervical spine osteochondroma [1], cavernoma [4, 5], multiple sclerosis, schwannoma [2, 8], meningioma [12], and myelitis [3, 9]. Though MRI examination was not conducted in all family members, the MRI results of the index patient and his second daughter had excluded local pathologies thus indicating idiopathic ON.…”