SUNCT syndrome with paroxysmal mydriasis: Clinical and pupillometric findings

Abstract

SUNCT syndrome (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing) is a primary headache characterised by a high frequency of attacks associated with marked autonomic periocular signs and symptoms. Activation of the hypothalamus via the superior salivary nucleus is probably responsible for some of the autonomic involvement observed during SUNCT attacks. We describe a case of SUNCT with unusual autonomic features (e.g., mydriasis) and early onset. Pupillometric studies were performed both in a basal condition (without anisocoria) and after instillation of phenylephrine (a drug with direct sympathomimetic activity) and pilocarpine (a parasympathetic agonist). The findings in this patient seem to indicate involvement of the ocular sympathetic supply in SUNCT, responsible for the mydriasis, and seem to strengthen the possibility that the autonomic phenomena in this syndrome vary with different levels of pain severity.

Short‐Lasting Unilateral Neuralgiform Headache With Autonomic Symptoms Syndrome as the Initial Manifestation of Idiopathic Hypertrophic Cranial Pachymeningitis

“…Transient miosis probably represents an additional parasympathetic feature, along with his other autonomic symptoms of conjunctival injection. Miosis has not been previously reported with SUNA syndrome, but paroxysmal mydriasis, a sympathetic feature, has been documented in atypical presentations of SUNCT syndrome 10 …”

A rare case of short-lasting unilateral neuralgiform headache with conjunctival injection and tearing with progression to neuromyelitis optica spectrum disorder

“…Antonaci et al. 7 described a patient with SUNCT syndrome who exhibited paroxysmal mydriasis, and they assumed that the involvement of the ocular sympathetic innervation was responsible for the mydriasis. SUNCT is more common in men than women.…”

“…4 The condition is characterized by the occurrence of at least 20 attacks lasting for 1 to 600 s. 6 However, there are descriptions of bizarre clinical cases involving peculiar aspects that can be misleading in clinical practice. Antonaci et al 7 described a patient with SUNCT syndrome who exhibited paroxysmal mydriasis, and they assumed that the involvement of the ocular sympathetic innervation was responsible for the mydriasis. SUNCT is more common in men than women.…”

Unilateral mydriasis after video-assisted thoracic thymectomy: case report and review of literature

“…Мидриаз вследствие пароксизмальных эпизодов симпатической гиперстимуляции может быть составной частью эпилептических припадков [75], SUNCT-синдрома (кратковре-менная односторонняя невралгиформная го-ловная боль в сочетании с конъюнктивальной инъекцией и слезотечением), обусловленного раздражением верхнего слюноотделительно-го ядра [6], а также ирритацией звездчатого ганглия с развитием антипода и предвестни-ка синдрома Клода Бернара -Горнера (птоз, миоз и энофтальм) -синдрома Пурфюр дю Пти (Pourfour du Petit), включающего в себя мидриаз, ретракцию век, экзофтальм, иногда гипергидроз ипсилатеральной половины лица и верхней конечности [7,18,35,55,66]. Ве-роятный механизм -раздражение (например, вследствие деформации позвонка, травмы или опухолевого роста, затруднённого венозно-го оттока) шейного симпатического сплете-ния на уровне проксимальной порции первого дорcального корешка [20,25,55].…”