Recurrence of Cluster Headache After Carotid Thrombendarterectomy

Björne, Annika; Hindfelt, Bengt; Havelius, Ulf

doi:10.1111/j.1526-4610.1994.hed3404230.x

Cited by 18 publications

(20 citation statements)

References 3 publications

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“…In this patient, lacking any clinical evidence of a Homer-like syndrome, we found by pharmacological pupillary testing (with phenylephrine and tyramine) evidence of a subclinical ipsilateral sympathetic dysfunction (Bjorne et al, 1994). As we postulated that postganglionic sympathetic nerve dysfunction might be pathophysiologically pertinent, we 352 European Journal of Neurology .…”

Section: Introductionmentioning

confidence: 95%

Cephalic postganglionic sympathetic involvement in cluster headache–as evidenced by the pupillary responses to phenylephrine and tyramine

Havelius

Milos

Hindfelt

1997

Euro J of Neurology

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Twenty-six patients with episodic cluster headache were subjected to pupillometric examinations of the responses to bilateral conjunctival instillations of a single drop of a 1% phenylephrine and a 2% tyramine hydrochloride solution. Five patients had a Horner-like syndrome on the symptomatic side, where they exhibited an increased pupillary response to phenylepbrine and a decreased response to tyramine, i.e. a pattern compatible with postganglionic sympathetic dysfunction. It is suggested that these patients constitute a subgroup among the patients with cluster headache. The pupillary response to phenylephrine was frequently increased on the symptomatic side, while that to tyramine was reduced. This may indicate dysfunction of the sympathetic postganglionic fibers to the iris (and tentatively to the cephalic vasculature). Such an interpretation may be supported by the finding that a marked mydriatic response on the symptomatic side to tyramine was associated with an inactive cluster headache, frequently over many years.

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Section: Introductionmentioning

confidence: 95%

Cephalic postganglionic sympathetic involvement in cluster headache–as evidenced by the pupillary responses to phenylephrine and tyramine

Havelius

Milos

Hindfelt

1997

Euro J of Neurology

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“…It was concluded that the relapse might possibly be secondary to peroperative damage of the carotic sympathetic plexus. 29 By pharmacological testing of the pupil with phenylephrine and tyramine, we found no convincing evidence of a persistent sympathetic dysfunction (Figure 2). The results were equivocal.…”

Section: Clinical Features Of Sellar/suprasellar and Parasellar Pathomentioning

confidence: 99%

“…However, he exhibited manifestations of transient sympathicoparesis, typical of acute attacks of cluster headache. [26][27][28][29] Recently, a patient was reported who, after 20 years of freedom from chronic cluster headache, had a relapse after a carotid thrombendarterectomy. It was concluded that the relapse might possibly be secondary to peroperative damage of the carotic sympathetic plexus.…”

Section: Clinical Features Of Sellar/suprasellar and Parasellar Pathomentioning

confidence: 99%

Clusterlike Headache in a Patient With a Pituitary Adenoma. With a Review of Literature

1996

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A man had left-sided atypical clusterlike headache for II years before he developed symptoms and signs consistent with acromegaly. Preoperative evaluation revealed raised levels of somatomedin C and growth hormone. An MR indicated a left-sided intrasellar mass measuring 8 x 7.5 x 10 mm. He underwent surgery and microscopy confirmed the diagnosis of a benign hypophyseal adenoma. Postoperatively, the acromegalic features regressed, and for the last 4 years the patient has been completely free from headache attacks. On pharmacological testing of the pupillary response to 19 and 5% phenylephrine and 2% tyramine solutions, there was no convincing evidence of persistent sympathetic dysfunction on the earlier symptomatic side.Key words: acromegaly, clusterlike headache, phenylephrine pituitary adenoma, pupil, tyramine Abbreviations: GH growth hormone (Headache 1996;36:184-188) The pathophysiology of cluster headache remains unclear. In most instances, every extensive neurological and neuroradiological examinations will be normal. 1 However. symptomatic clusterlike headache has been reported in a variety of pathological conditions with varying locations. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Recently, pathophysiological interest has been focused on basal midline structures and in particular, the cavernous sinus. [17][18][19][20][21][22][23] We report a case of clusterlike headache associated with an intrasellar pituitary adenoma causing acromegaly. The relevance of the tumor location and its possible implications for the symptomatology, particularly with respect to sympathetic dysfunction, are discussed. CASE HISTORYA 37-year-old man had suffered from left-sided headache attacks for 4 years before he sough medical advice at the Department of Neurology Malmö University Hospital in 1985. His previous history was unremarkable. The headache was strictly left-sided and located behind the eye; radiating towards the left ear, the occiput, and the neck. Because the pain also involved the teeth in the left upper jaw, he had undergone dental treatments, including correction of bite, all of which had been in vain.The attacks occurred with varying intervals of weeks or months. The pain was excruciating, with a stinging and pulsating character. It always started at about the same time in the afternoon and lasted for up to 7 or 8 hours. The patient could only get some relief by a high intake of phenacetin and acetylsalicylic acid. However, by pouring hot water over the neck or by massaging the occipital region on the left side, he could also obtain considerable relief. The pain never sub sided completely before he went to bed. Initially, when the headache attacks started, he thought that attacks could be provoked by intense sunlight, shimmering waves, but also by a cold wind blowing in the face. Whenever he suffered an attack, his left eye was reddened with markedly increased lacrimation. The left nostril was blocked and there was rhinorrhea. During an attack, he did not experience nausea, nor did he ever vomit. Som...

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“…In one case, Bjorne et al [38] reported a patient with a 22-year remission period from CH who experienced attacks on the day after carotid thrombendarterectomy. CLH was similar in all ways to that suffered two decades before and was located on the same side as the arterial vascular surgery.…”

Section: Clh and Cranial Vesselsmentioning

confidence: 99%