Headache Medicine 2021, 12(1) p-ISSN 2178-7468, e-ISSN 2763-6178

ASAA

DOI: 10.48208/HeadacheMed.2021.15

Headache Medicine

Image in Headache Medicine

Brainstem tumor as a cause of headache triggered by Valsalva maneuver

Marcelo Moraes Valença

Martina Falcão Valença

Juliana Ramos de Andrade

Elayne Cristina de

Oliveira Ribeiro

Luiz Severo Bem Junior

Ana Cristina Veiga Silva

Rita de Cássia Ferreira Valença

Mota

Ubiratan Alves Viturino da Silva

José Ronaldo Lessa Angelo Júnior

Federal University of Pernambuco, Recife, Pernambuco, Brazil.

International Neuroscience Institute-Hannover, Germany

Expansive lesions of the posterior fossa or the malformation in the occipitocervical transition can

cause headache triggered by Valsalva maneuver, usually of sudden onset and of signicant intensity,

which usually lasts for a short time.

1-7

Brainstem tumor is rarely related to cause headache

, hence the

interest in documenting this patient's case in this article.

Figure 1 shows an MRI image of the head of a 26-year-old woman who reported a history of

headaches from straining to defecate and when sneezing, with a gradual progression in the previous

three years. Pain is holocranial, of sudden onset, very severe, lasting a few seconds or minutes.

Figure 1. MRI of an expansive/inltrative lesion affecting the brainstem, particularly the left pons and the left

middle cerebellar peduncle, and partially the cerebellar hemisphere, extending beyond the midline to the right

in the pons. The lesion expands anteriorly, signicantly reducing the prepontine cistern, partially involving the

basilar artery (arrow), slightly shifting to the right. Due to compression of the cerebrospinal uid pathways, there

is a slight dilation of the supratentorial ventricles, without signs of ependymal transudation. There is a herniation

of the cerebellar tonsils through the foramen magnum (arrow heads).

Marcelo Moraes Valença

mmvalenca@yahoo.com.br

Received: August 26, 2021

Accepted: August 27,2021

Keywords:

Valsalva Maneuver

Intracranial Pressure

Sneezing

Magnetic Resonance

Imaging

Brain Stem Neoplasms

Neuroimaging

Edited by

Mario Fernando Prieto

Peres

ASAA

Valença MM, Valença MF, Andrade JR, Ribeiro ECO, Bem Junior LS, Silva ACV, Mota RCFV, Silva UAV, Angelo Junior JRL

Brainstem tumor as a cause of headache triggered by Valsalva maneuver

She now has a mild motor decit in the right lower limb,

mild peripheral facial palsy on the left, and hypoesthesia

in the left hemiface.

The secondary herniation of the cerebellar tonsils through

the foramen magnum may change the cerebrospinal uid

dynamic signicantly, causing abrupt elevation of the

intracranial pressure, triggering painful mechanisms.

9,10

Although headaches triggered by the Valsalva maneuver

may be considered benign, patients with such complaints

should be investigated by neuroimaging.

11,12

Author’s contribution: MMV – Conceptualization, Investigation,

Writing - Original Draft and Supervision; MFV, JRA, ECOR, LSBJr,

ACVS, RCFVM, UV - Writing - Review & Editing and Visualization;

JRLA – Investigation, Data Curation and Supervision

Marcelo Moraes Valença

https://orcid.org/0000-0003-0678-3782

Martina Falcão Valença

https://orcid.org/0000-0002-4085-3118

Juliana Ramos de Andrade

https://orcid.org/0000-0002-5445-8872

Elayne Cristina de Oliveira Ribeiro

https://orcid.org/ 0000-0002-5243-3356

Luiz Severo Bem Junior

https://orcid.org/0000-0002-0835-5995

Ana Cristina Veiga Silva

https://orcid.org/0000-0002-1149-4427

Rita de Cássia Ferreira Valença Mota

https://orcid.org/0000-0003-3588-788X

Ubiratan Alves Viturino da Silva

https://orcid.org/0000-0002-7715-8258

José Ronaldo Lessa Angelo Júnior

https://orcid.org/0000-0002-4772-3471

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