The Enhanced Ciliospinal Reflex in Asymptomatic Patients With Cluster Headache is Due to Preganglionic Sympathetic Mechanisms

Havelius, Ulf; Heuck, Martin; Milos, Peter; Hindfelt, Bengt

doi:10.1046/j.1526-4610.1997.3708496.x

Cited by 7 publications

(3 citation statements)

References 3 publications

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“…IVP studies have also found a decreasing PD with age [18], as shown in our cohort, with a very good correlation between these two techniques. It is noteworthy that there are no systematic CR data measured by IVP that are directly comparable to our setting (UP), although available series obtained similar results in terms of percentage of pupillary dilatation [13,19]. Interestingly, IVP and UP findings were comparable only when higher levels of nociceptive electrical stimulation were applied.…”

Section: Discussionsupporting

confidence: 49%

Ultrasound Examination of the Pupil – A New Tool for the Neuro-Ophthalmological Assessment

et al. 2020

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Background Pupil examination represents a diagnostic and prognostic test in the management of several neurological diseases. Infrared video pupillometry (IVP) is the gold standard, since it is not routinely available, a noninvasive bedside ultrasound assessment has been proposed as an alternative. The aim of this study was to assess the feasibility and reproducibility of ultrasound pupillometry (UP) in comparison with IVP. Materials and Methods 81 subjects (43 men and 38 women, mean age: 52 ± 20 years and 49 ± 19 years, respectively) with no history of neurophthalmologic disease were enrolled. UP was performed with a 12-MHz linear probe according to current guidelines for orbital insonation. Light and painful stimuli were applied to test pupillary light reflex (PLR) and ciliospinal reflex (CR). In 30 of these subjects IVP examination was performed additionally to obtain intra-observer and inter-observer agreement. Results Increasing age was associated with a decreased pupillary diameter (PD) at rest, after PLR and CR (R –0.728, p < 0.01, R –0.643, p < 0.01, R 0.674, p < 0.001 respectively), while no association was noticed with time to constriction/dilation. UP measurements were reproducible (rate of inter- and intra-observer agreement: R 0.979, p < 0.01, R 0.946, p < 0.01 respectively) and concordant with IVP (PLR R 0.831, p < 0.01; CR R 0.879, p < 0.01). Conclusion According to our study, ultrasound pupillometry is a feasible and reliable technique for bedside pupillary function assessment, and is a good alternative to infrared video pupillometry. Moreover, it represents the only way for functional pupillary assessment in patients with periorbital hematoma.

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Section: Discussionsupporting

confidence: 49%

Ultrasound Examination of the Pupil – A New Tool for the Neuro-Ophthalmological Assessment

et al. 2020

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“…Indeed, in the superior pericarotid cavernous sinus plexus, fibres from the first trigeminal division as well as sympathetic fibres from the superior cervical ganglion and parasympathetic fibres from the greater petrosal nerve to the sphenopalatine ganglion are located next to each other. It has also been shown that idiopathic cluster headache is related to central or peripheral autonomic dysfunction (10–12), and in some patients there is a persisting sympathetic deficit after the cluster attacks (10, 13). Imaging studies have demonstrated changes in the posterior hypothalamus, an area also important for autonomic regulation (14), and evidence for the involvement of parasympathetic fibres has been reported (10).…”

Section: Introductionmentioning

confidence: 99%

Two Cases of Symptomatic Cluster-Like Headache Suggest the Importance of Sympathetic/Parasympathetic Balance

et al. 2007

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Despite several reports on symptomatic cluster-like headache, there is no clear explanation of how different lesions thought to be causative are related to cluster-like headache. On the basis of two additional cases of symptomatic cluster headache, we discuss the possibility that an acute imbalance of the autonomic nervous system, namely a net overactivity of the parasympathetic system, may be able to trigger these headache attacks in patients who probably have an additional individual predisposition to react with a cluster-like headache. Such an imbalance can be due to an increase in parasympathetic tone (e.g. stimulation of parasympathetic fibres) or to a reduction of the sympathetic tone (e.g. a lesion of the sympathetic fibres).

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“…Havelius et al 8 reported a reduced response of the ciliospinal reflex of the symptomatic pupil in patients with CH and Horner's. Conversely, an enhanced response was observed in symptomatic patients with CH and no Horner's, possibly due to preganglionic sympathetic mechanisms 8,9 …”

Section: Discussionmentioning

confidence: 99%

Status Migrainosus and Adie's Syndrome

Jacome¹

2002

Headache

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Abbreviations: SM status migrainosus, CNS central nervous system, CH, cluster headache, AP Adie's pupil, CT computerized tomography, MRI/MRA, magnetic resonance imaging and angiography ( Headache. 2002;42:793-795) Status migrainosus (SM) is a migraine variant characterized by severe headache persisting beyond three days sometimes accompanied by nausea and vomiting. 1 Although a serious central nervous system (CNS) pathology is usually absent, exceptional patients may exhibit arterial segmental stenosis and dilatations visualized by cerebral arteriography suggesting the presence of an underlying inflammatory angiopathy. 2 In this paper, a patient is described with acute onset of prolonged, pulsatile left frontal and orbital headache associated with ipsilateral pupillary dilatation lasting for several months and followed by the development of new headache and contralateral pupillary dilatation. There was no evidence of a structural CNS lesion, and by clinical examination, she had Adie's pupil and polyneuropathy (Adie's syndrome). CASE REPORTA 27-year-old female was sent for neurological evaluation because of headache, blurred vision, and dilatation of the left pupil. She reported the abrupt onset of severe left frontal and orbital headache for 2 months prior, with continuous headaches since then. She reported an 8-year history of similar headaches, but never associated with blurred vision or with di-lated pupils. Her previous headaches were less intense and did not last more than 1 or 2 days on the average. She had no symptoms of systemic or infectious illnesses. She had no history of syncope or postural hypotension and no history of bladder or bowel disturbance. She had no dry mouth or eyes. Her past medical history was significant for hypertension and anxiety disorder treated with hydrochlorothiazide 25 mg qid and paroxetine 20 mg qid. She had a sister with migraine.Her blood pressure was 160/100, her apical pulse was 78 per minute, her respiratory rate was 20 per minute, and she was afebrile. General physical examination was normal. On neurological examination, she had normal mental status, muscle strength, gait, and cerebellar and sensory testing, including the face. There was no facial weakness and no weakness or atrophy of the tongue. On ophthalmological examination, she had anisocoria. The left pupil was dilated and did not respond to light stimulation, but slowly constricted with convergence (near response). Her visual acuity was 20/25 in the left eye and 20/20 in the right eye, uncorrected. She complained of severe pounding left frontal and orbital pain, but there was no exophthalmos or conjunctival inflammation. There was no ptosis. Extraocular movements were normal. On slit lamp exam, the corneas and lenses were clear. There was sectorial atrophy of the left iris with vermicular contractions. Her right eye examination was normal and her eye grounds showed normal retina and normal vessels and optic nerves. Her ocular pressure was 18 in the left eye and 12 in the right. Gold-

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The Enhanced Ciliospinal Reflex in Asymptomatic Patients With Cluster Headache is Due to Preganglionic Sympathetic Mechanisms

Cited by 7 publications

References 3 publications

Ultrasound Examination of the Pupil – A New Tool for the Neuro-Ophthalmological Assessment

Ultrasound Examination of the Pupil – A New Tool for the Neuro-Ophthalmological Assessment

Two Cases of Symptomatic Cluster-Like Headache Suggest the Importance of Sympathetic/Parasympathetic Balance

Status Migrainosus and Adie's Syndrome

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