Dados do Trabalho

Título

Trigeminal autonomic cephalalgia attributed to ischaemic stroke: a case report

RESUMO

Case presentation
A 42-year-old man, with hypertension presented with complete right hemi-hypoesthesia, hemiparesis, and sudden aphasia 2 years ago. He had no previous history of headaches. Just a few minutes before these neurological symptoms, he had a severe left temporal headache. Since then, he continued presenting episodes of headache with the same characteristics, two to three times a week, associated with psychomotor restlessness, ipsilateral conjunctival injection, and lacrimation, which lasts about 90 minutes but occasionally exceeds 10 hours. The admission CT of the brain in the emergency room was normal, but the MRI three months later evidenced a hypointense lesion in the left pons region. Indomethacin 75mg three times a day, carbamazepine 200mg twice a day, and propranolol 40mg twice a day were started, but without a good response. Due to the suspicion of secondary cluster headache, a neural block with lidocaine and dexamethasone of the greater occipital nerve on the left was performed and the use of sodium divalproate 500mg daily was started. A 2-month follow-up showed a 90% decrease in headache attacks.

Discussion
Primary trigeminal autonomic cephalalgias(TACs) are a rare group of headache disorders. (1) A high number of secondary cases of TACs were described with clinical features equal to primary TACs, and become a diagnostic challenge, being fundamental for the diagnosis of a complete and careful anamnesis. (3) Qi Lei et al. described a case of SUNC secondary to brainstem infarction, demonstrating the association of infarction of this topography and trigeminal autonomic cephalgia. (4)

Final comments
We reported a case of trigeminal autonomic cephalgia secondary to ischemic vascular injury. Despite being a rare condition, it can lead to high morbidity. Be aware of this diagnostic possibility promotes a better functional outcome for the patient.