Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing-like attacks in a pediatric patient found to have a pontine capillary telangiectasia and developmental venous anomaly: A case report exploring the root of the problem

Author:

Liapounova Natalia A1,VanderPluym Juliana H1,Bhargava Ravi2,Kolski Hanna H1

Affiliation:

1. Department of Pediatric Neurology, University of Alberta, Edmonton, AB, Canada

2. Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada

Abstract

Introduction Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT)-like attacks are rarely reported in the pediatric population and may remain undiagnosed and under-investigated as a result. Case presentation We present a case of a 15–year-old male with intermittent, episodic, right-sided brief headaches most in keeping with SUNCT, initially diagnosed as paroxysmal hemicrania, but with no response to indomethacin. The pain was likewise not responsive to typical migraine treatments or steroids. Management and outcome Contrast-enhanced magnetic resonance imaging demonstrated a right pontine capillary telangiectasia with an associated developmental venous anomaly that was adjacent to the root of the right trigeminal nerve. Differential diagnosis included first division trigeminal neuralgia with autonomic features. The patient’s pain was partially alleviated by oxygen administration and responded well to carbamazepine; he remained pain free on carbamazepine a year later. Conclusion This case highlights the diagnostic dilemma of differentiating SUNCT from trigeminal neuralgia with autonomic features, both of which are rare diagnoses in pediatric patients, and the importance of appropriate neuroimaging to rule out secondary causes in patients presenting with trigeminal autonomic cephalalgias, recognizing that abnormalities identified on neuroimaging, such as vessels adjacent to the trigeminal nerve, may not be causative findings.

Publisher

SAGE Publications

Subject

Neurology (clinical),General Medicine

Cited by 5 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Cranial Neuralgias in Children and Adolescents A review of the literature;Seminars in Pediatric Neurology;2021-12

2. SUNCT and SUNA: An Update;Neurology India;2021

3. Uncommon Pediatric Primary Headache Disorders;Pediatric Annals;2018-02

4. Secondary (Symptomatic) trigeminal autonomic cephalalgia;Annals of Indian Academy of Neurology;2018

5. Carbamazepine;Reactions Weekly;2017-11

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