Bilateral SUNCT syndrome associated to chronic maxillary sinus disease

Abstract

-SUNCT syndrome (short lasting unilateral neuralgiform headache with conjuntival injection and tearing) is defined as short attacks of periorbital unilateral pain and accompanied by ipsilateral lacrimation and redness of the same eye. We present an unusual SUNCT case with bilateral pain that started five years ago after an acute maxillary sinus infection that evolved to chronic sinusitis. This association has been described in few SUNCT cases, but its causal role remains uncertain. The patient was a 58 years old man that fulfilled a headache diary that showed the usual circadian pattern, worsening in the morning and afternoon, and responded to treatment with gabapentina. He was submitted to a functional endoscopic sinus surg e ry and evolved with milder pain. In a review of 21 patients, 5 had a past medical history of sinusitis, but the causal role of this association remained uncertain. KEY WORDS: SUNCT, bilateral, sinusitis, gabapentinaSíndrome SUNCT de ocorrência bilateral associada a sinusopatia maxilar crônica RESUMO -A síndrome SUNCT (short lasting unilateral neuralgiform headache with conjuntival injection and tearing) é definida como curtos ataques de dor periorbital unilateral, acompanhada de lacrimejamento e h i p e remia conjuntival ipsilateral. Apresentamos um raro caso de SUNCT com dor bilateral com evolução de cinco anos e iniciado após uma infecção de seio maxilar que evoluiu para sinusite crônica. Esta associação foi descrita em poucos casos de SUNCT, porém pouco esclarecida. O paciente era um homem de 58 anos que p reencheu um diário de dor que demonstrou o típico padrão circadiano da síndrome, com pioras matinais e vespertinas, e apresentou melhora com uso de gabapentina. Submetido a ciru rgia endoscópica funcional em seio maxilar e evoluiu com modulação da dor, sugerindo um potencial efeito benéfico após tratamento da sinusopatia.Na revisão de literatura encontramos 21 casos de SUNCT bilateral, cinco dos quais apresentavam história de sinusite; no entanto, a relação entre as duas entidades permanece ainda incert a . PALAVRAS-CHAVE: SUNCT, bilateral, sinusite, gabapentina. CASEWe re p o rt on a 58-year-old non white male with a past medical history of bilateral lachrymal duct surgeries and trauma in the left forehead in his infancy, who suff e re d from periorbital stabbing eye pain lasting 5 to 10 seconds accompanied by conjuntival injection and tearing. The attacks started five years ago after he had an acute maxillary sinus infection presenting with proptosis and lateral deviation of the left eye due to fronto-ethmoidal mucocele, diagnosed by CT scan, requiring surgical drainage of the paranasal sinuses. After this intervention he developed chro nic sinusitis, confirmed with CT and MRI scans (Fig 1). A few weeks after the pro c e d u re he evolved stabbing eye pain described as "a needle sticking into my eye", lasting 5 to 10 seconds, accompanied by conjuntival injection and tearing, that could be triggered by cold weather and forceful reading. Although he w as not able t o count, h...

Secondary Short-Lasting Unilateral Neuralgiform Headache with Conjunctival Injection and Tearing: A New Case and a Literature Review

“…We summarized 69 cases of SUNCT-like conditions associated with certain etiologies in 62 English-language studies reported on from 1991 to 2017 and for which there were detailed descriptions of the clinical features and imaging results of the patients. These cases comprised 17 with neoplasm, 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 35 with neurovascular disease, 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 2 with trauma, 44 45 10 with infection, 46 47 48 49 50 51 52 53 54 3 with inflammatory disease, 55 56 57 and 2 with congenital malformation ( Table 1 , 2 , and 3 ). 58 59 …”

Symptomatic SUNCT Syndrome Associated With Ipsilateral Paranasal Sinusitis

“…There have been cases of SUNCT syndrome resulting from craniosynostosis associated with seborrheic dermatitis 9 or intra‐orbital metastatic tumor 10 . A case of SUNCT syndrome associated with chronic sinusitis was recently reported, but atypical attacks with bilaterality and incomplete surgical response in terms of pain obscured the causal relationship between SUNCT syndrome and underlying sinusitis 11 . Another report of a case series of SUNCT syndrome suggested that the presence of sinusitis is likely to be an incidental finding in patients with SUNCT 12 .…”

“…While several symptomatic cases with intracranial lesions have been reported, 2‐8 SUNCT syndrome associated with extracranial lesions is very uncommon 9,10 . Although a few cases of SUNCT associated with sinusitis have been reported, 11,12 the relationship between sinusitis and SUNCT syndrome remains unclear. Here, we describe a case of symptomatic SUNCT syndrome caused by sinusitis, fulfilling the criteria of International Headache Society classification for SUNCT, which completely resolved after treatment of sinusitis.…”

Headache Research and Medical Practice in Brazil: An Historical Overview

“…A number of the early articles on headache disorders were published by Farias da Silva and coworkers in the scientific journal Neurobiologia (Recife), which is one of the oldest journals in the area of neurology in Latin America, founded in 1943 by Ulysses Pernambucano. Another important journal containing articles on headache written by Brazilians is Arquivos de Neuropsiquiatria , which was founded in 1945 …”