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58 Headache Medicine, v.8, n.2, p.58-59, Apr./May/Jun. 2017
Cluster-tic syndrome: case report and literature review
Síndrome salvas-tic: relato de caso e revisão da literatura
Marcos Rafael Porto Bioca Alves
1
, Marcelo Moraes Valença
2
1
Medical student, Catholic University of Pernambuco
2
Neurosurgery and Neurology Unit, Federal University of Pernambuco, Recife, PE, Brasil
Alves MRPB, Valença MM. Cluster-tic syndrome: case report and literature review. Headache Medicine. 2017;8(2):58-9
CASE REPORT
INTRODUCTION
Cluster-tic syndrome is a rare and curious clinical
condition characterized by cluster headache coexisting with
ipsilateral trigeminal neuralgia.
(1-14)
The first component represents severe unilateral
throbbing attacks in the periorbital or temporal areas
commonly associated with facial autonomic symptoms, such
as lacrimation, rhinorrhea, conjunctival hyperemia, nasal
congestion and palpebral fissure narrowing. In association
with this trigeminal neuralgia also occurs, characterized by
an ipsilateral paroxysm sharp, shock-like pain (triggered by
facial or intraoral stimuli). Moreover, the onset of trigeminal
symptoms can occur before or concomitant to the beginning
of an attack of a cluster headache, affecting ophthalmic
and maxillary branches, without reports referring mandibu-
lar region envolviment.
(1,7)
This syndrome has been reported as secondary to
intracranial lesions and may be the initial manifestation
of pituitary adenoma,
(4)
multiple sclerosis,
(3)
and dural
carotid-cavernous fistula.
(9)
Also, the trigeminal attacks
were described not only due to arterial compression but
also caused by basilar artery ectasia, prolactinoma,
epidermoid tumor, pituitary adenoma or a venous
participation, more precisely, with a petrosal vein pressure
on the nerve.
(1-5,7,9)
CASE REPORT
A 53-year-old woman with two years history of severe
intensity attacks of pain, located on the right
orbitotemporal region, with all the characteristics of
trigeminal neuralgia. Concomitantly, she also reported
right side pain on the orbit, with duration of 15 min,
associated with eyelid ptosis and lacrimation. It was tried
indomethacin for a few weeks with no success. The two
different types of pain were completely abolished with
low doses of carbamazepine (200 mg per day) and
verapamil (240 mg per day). No abnormality was
observed in MRI of the brain.
COMMENT
The cluster-tic syndrome occurs more likely in the middle
age, except two patients with 28 and 79 years of age,
respectively, observed in the present review.
(1,3,4,6-9,11,13,14,17)
An improvement of the trigeminal attacks as a
response to the cluster headache treatment was described.
However, when this option is not sufficient, trigeminal neu-
ralgia treatment could be considered. The association of
carbamazepine and lithium showed a positive effect in
the tic component of the pain, with an inadequate response
to cluster headache attacks.
(8)
First line treatment in acute
situations resides in oxygen inhalations, requiring verapamil
and prednisone in preventive approuch
(1,13,14)
In patients
who are not benefited by this therapy, surgical
decompression of the V nerve is recomended.
(1,7,9,10,13)
REFERÊNCIAS
1. De Coo I, van Dijk JMC, Metzemaekers JDM, Haan J. A Case
Report About Cluster-Tic Syndrome Due to Venous
Compression of the Trigeminal Nerve. Headache J Head Face
Pain 2016;1-4.
2. Favier I, van Vliet JA, Roon KI, et al. Trigeminal autonomic
cephalgias due to structural lesions: A review of 31 cases.
Arch Neurol. 2007;64:25-31.