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

, Marcelo Moraes Valença

Medical student, Catholic University of Pernambuco

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

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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.

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3. González-Quintanilla V, Oterino A, Toriello M, de Pablos C,

Wu Y, de Marco E, et al. Cluster-tic syndrome as the initial

manifestation of multiple sclerosis. J Headache Pain. 2012

Jul;13(5):425-9.

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resolved by removal of pituitary adenoma: The first case.

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5. Levyman C, Dagua Filho Ados S, Volpato MM, Settanni FA, de

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Feb;11(1):33-6.

6. Monzillo PH, Sanvito WL, Da Costa AR. Cluster-tic syndrome:

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(2B):518-21.

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Cluster-tic syndrome and basilar artery ectasia: a case report.

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9. Payán Ortiz M, Guardado Santervás P, Arjona Padillo A,

Aguilera del Moral A. Cluster-tic syndrome as the first clinical

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11. Uca AU, Kozak HH. Cluster-tic syndrome and bilateral internuclear

ophthalmoplegia as the manifestation of multiple sclerosis. Neurol

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CLUSTER-TIC SYNDROME: CASE REPORT AND LITERATURE REVIEW

Received: June 05, 2017

Accepted: June 12, 2017

Correspondência

Marcos Rafael Porto Bioca Alves

Catholic University of Pernambuco

Rua do Príncipe, 526

50050-900 – Recife, PE, Brazil

Email: rafabioca@yahoo.com.br