Headache Medicine 2021, 12(1) p-ISSN 2178-7468, e-ISSN 2763-6178
70
ASAA
DOI: 10.48208/HeadacheMed.2021.15
Headache Medicine
© Copyright 2021
Image in Headache Medicine
Brainstem tumor as a cause of headache triggered by Valsalva maneuver
Marcelo Moraes Valença
1
Martina Falcão Valença
2
Juliana Ramos de Andrade
1
Elayne Cristina de
Oliveira Ribeiro
1
Luiz Severo Bem Junior
1
Ana Cristina Veiga Silva
1
Rita de Cássia Ferreira Valença
Mota
1
Ubiratan Alves Viturino da Silva
1
José Ronaldo Lessa Angelo Júnior
1
1
Federal University of Pernambuco, Recife, Pernambuco, Brazil.
2
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 signicant intensity,
which usually lasts for a short time.
1-7
Brainstem tumor is rarely related to cause headache
8
, 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/inltrative 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, signicantly 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
71
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 decit 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 signicantly, 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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