Symptomatic Cluster Headache in Internal Carotid Artery Dissection—Consider Anhidrosis

Frigerio, Susanna; Bühler, Robert; Heß, Christian; Sturzenegger, Matthias

doi:10.1046/j.1526-4610.2003.03169.x

Cited by 34 publications

(28 citation statements)

References 23 publications

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“…Atypical pain, localisation of pain over face or eye, and accompanying neck pain suggest ICAD rather than cluster headache. Lack of anhidrosis accompanying Horner's syndrome during a headache has been postulated to suggest ICAD (as fibres pass along the external carotid plexus) 8 .…”

Section: Discussionmentioning

confidence: 99%

Internal carotid artery dissection presenting as cluster headache

Godeiro-Júnior

Kuster

Felı́cio

et al. 2008

Arq. Neuro-Psiquiatr.

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Cluster headache (CH) is a clinical entity characterized by strictly unilateral head pain attacks accompanied by ipsilateral autonomic phenomena. The attacks are severe, short-lasting (15-180 minutes), and may occur several times a day 1 . Symptomatic CH cases have been described in association with different kind of lesions located in the middle fossa, near the sellar or parasellar structures although lesions of the internal carotid artery (ICA) were also described: aneurysma of ICA and internal carotid artery dissection (ICAD) 2 . We report a patient with symptomatic CH secondary to ICAD, and complete remission of his symptoms with usual treatment for CH. We obtained informed constent from the patient for publication. CaSeA 53-year-old white man presented to the emergency room of Hospital Israelita Albert Einstein with 10-day history of recurrent right peri-orbital headache. Headaches were sudden, severe, pulsating, of thirty minutes duration and occurred once or twice a day. Headache was accompanied by ipsilateral ptosis, conjunctival injection, lacrimation and nasal stuffiness. He was on treatment for mild hypertension with hidroclorotiazide 25 mg once a day. Examination during headache revealed right Horner's syndrome with partial ptosis and miosis, accompanied by ipsilateral lacrimation, eyelid edema and conjunctival injection. After this episode, he remained with mild right ptosis. The remaining cranial nerves and neurological examination were normal.The above features satisfied criteria "A to D" for CH of the International Classification of Headache Disorders (number, site and duration, accompanying symptoms, frequency of headaches) 1 . Criterion E stipulates that other causes for the headache must be ruled out. We therefore performed further investigations. Computed tomographic imaging of the brain was normal. Fat supression T1-weighted magnetic resonance imaging of the carotid canal level displayed high signal compatible with blood products within the wall of the right internal carotid what was sugestive of arterial dissection (Figure).He was admitted in our critical care unit and complementary investigation was performed. Blood cell count, erythrocyte sedimentation rate, coagulogram, protein C and protein S, lipidogram were normal. Results from a heart survey, including Holter's monitor and echocardiography, were normal.The patient was anti-coagulated. Verapamil and prednisone were initiated as prophylactic therapy for cluster headache in our patient. There was complete resolution of headaches in one week and the patient was entirely asymptomatic at follow-up six months later.

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Section: Discussionmentioning

confidence: 99%

Internal carotid artery dissection presenting as cluster headache

Godeiro-Júnior

Kuster

Felı́cio

et al. 2008

Arq. Neuro-Psiquiatr.

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“…The lesions of the cervical sympathetic chain can be caused by carotid pathology, neoplastic infiltration, adenopathies or abscesses. (1,(6)(7)(8) Regarding iatrogenic causes, the incidence of CBHS resulting from video-assisted thoracoscopic sympathectomy has been shown to be 2.6%. (9) In a study conducted in Brazil in 2003, (10) a sample of 743 sympathectomy patients was analyzed, and the incidence of CBHS was reported to be 0.54%.…”

Section: Discussionmentioning

confidence: 99%

Síndrome de Claude Bernard-Horner associada ao empiema pleural

et al. 2006

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Claude Bernard-Horner syndrome presents various etiologies and occurs as the direct result of interrupted nerve signaling at any point along the nerve trajectory, be it intrathoracic or extrathoracic. Herein, we report a case of Claude BernardHorner syndrome caused by loculated pleural empyema located in the paravertebral region of the upper third of the right hemithorax. The patient was submitted to thoracotomy in order to drain the infected fluids. The end result was satisfactory, including resolution of the infection, pulmonary expansion, and remission of the syndrome.

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“…Second, 2 features of the depicted Horner syndrome are atypical features of autonomic symptoms in primary cluster headache: persistency of Horner syndrome during pain-free interval, and ipsilateral facial anhidrosis. [1][2][3] During primary cluster headache attacks, the typical finding is increased sweating of the ipsilateral forehead. 4 Third, the history of a twin brother with aneurysmal subarachnoid hemorrhage also deserves consideration.…”

Section: Sectionmentioning

confidence: 99%

Clinical Reasoning: A 62-year-old migraineur with a new kind of headache attacks

Bertschi

Sturzenegger²,

Heß³

2012

Neurology

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A 62-year-old man presented with novel headache attacks with acute onset 4 weeks previously strictly confined to the right side. The attacks occurred almost daily, often after midnight, lasting 1 to 3 hours, occasionally longer. The pain was localized around and behind the right eye. The pain intensity was excruciating and the pain quality pulsatile. Ipsilateral lacrimation, conjunctival injection, and prominence of the temporal artery accompanied these attacks. During the attacks, the patient reported a sense of restlessness. Alcohol consumption and physical activity provoked attacks. No recent major trauma was identified.In his personal history, the patient had had tension-type headache and mainly left-sided migraine-like headache attacks for many years. The latter were of a hammering quality, irradiating from the occipital to the frontal region, and accompanied by nausea, photophobia, and phonophobia. In comparison, the new onset current attacks clearly differed from the previous attacks in terms of location, pain quality, intensity, frequency, duration, and attendant symptoms. Ancillary diagnoses included arterial hypertension, treated with amlodipine, and ␣-1 antitrypsin deficiency.Family history revealed a twin brother, who died of aneurysmal subarachnoid hemorrhage 6 years previously. Several relatives had migraine.On clinical examination, reduced width of the palpebral fissure on the right side compared to the left (ptosis), right miosis, and anhidrosis of the forehead (figure 1, A and B) were noticed. These findings persisted during the pain-free interval.

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Symptomatic Cluster Headache in Internal Carotid Artery Dissection—Consider Anhidrosis

Cited by 34 publications

References 23 publications

Internal carotid artery dissection presenting as cluster headache

Internal carotid artery dissection presenting as cluster headache

Síndrome de Claude Bernard-Horner associada ao empiema pleural

Clinical Reasoning: A 62-year-old migraineur with a new kind of headache attacks

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