• Ozlem Coskun, Murat Ucar, Doga Vuralli, Funuzar Yildirim, Rumeysa Cetinkaya, Akin TakmazSunaSDepartment of Anesthesiology and Reanimation and Algology, Ankara Training and Research Hospital, Ankara, Turkey., and Serap Ucler.
• Departments of Neurology and Algology.
• Pain Med. 2017 Jul 1; 18 (7): 1377-1381.

BackgroundShort-lasting unilateral neuralgiform headache attack with conjunctival injection and tearing (SUNCT) is one of the trigeminal autonomic cephalalgias where neurovascular compression was detected in neuroimaging in recent years.CaseWe report two cases, a 52-year-old adult and a 69-year-old elderly patient with short-lasting and recurrent headache combined with cranial autonomic features. Diffusion tensor imaging (DTI) and magnetic resonance (MR) tractography of both patients outlined structural changes of the trigeminal nerve revealing neurovascular compression. Pain and autonomic symptoms were completely relieved in the 52-year-old patient who underwent microvascular decompression surgery.ConclusionTo our knowledge, this is the first time in the literature where MR tractography revealed structural changes in the trigeminal nerve secondary to neurovascular compression in SUNCT patients. We suggest that in SUNCT patients high-resolution magnetic resonance imaging (MRI) and/or DTI-MR tractography should be performed to exclude neurovascular compression. We propose that the compression of the trigeminal nerve could generate SUNCT symptoms and the posterior hypothalamus could be activated secondarily. With this point of view, trigeminal neuralgia and SUNCT could represent the different features of the neurovascular compression spectrum.© 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

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