SUNCT syndrome: clinical diagnostic difficulties

Publicado na 2ª edição de 2008

Introduction: SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing) syndrome is a rare condition characterized by marked impairment of the quality of life of affected patients. The disease is generally refractory to drug treatment, with few reports of cases of therapeutic success. Case report: We describe the case of a 60-year-old man seen at the headache outpatient clinic of Santa Casa de Belo Horizonte with a one-year history of signs and symptoms compatible with SUNCT syndrome. In view of the diagnostic difficulty and possible overlap of trigeminal neuralgia and SUNCT syndrome, the patient was first treated with carbamazepine, which resulted in an ineffective therapeutic response, and then with indomethacin and lamotrigine. Conclusion: Trigeminal neuralgia more commonly affects the second and third branches of this nerve and is characterized by a period of refractoriness after pain paroxysm in which no pain can be provoked, with this condition being responsive to partial or complete drug treatment. SUNCT syndrome is generally refractory to drug treatment, with isolated reports of therapeutic success with indomethacin, topiramate and lamotrigine. Although rare, neuralgia of the first branch of the trigeminal nerve is the main differential diagnosis of SUNCT syndrome. A literature review was performed.

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