Síndrome da cefaléia em salvas-nevralgia do trigêmeo: a propósito de dois casos

Monzillo, Paulo Hélio; Sanvito, Wilson Luiz; Peres, Mário Fernando Prieto

doi:10.1590/S0004-282X1996000200016

Resumos

São relatados dois casos da síndrome da cefaléia em salvas - nevralgia do trigêmeo. O primeiro caso, um paciente que apresentava crises do tipo trigeminal, do lado direito da face, acompanhadas de sinais autonômicos homolaterais do tipo lacrimejamento, coriza, congestão ocular, ptose palpebral parcial. As crises eram espontâneas ou desencadeadas por estímulos em "zonas de gatilho", com duração de segundos e numerosas ocorrências durante o dia. A periodicidade dos surtos era de aproximadamente 6 meses. Houve alivio dos sintomas quando da utilização de carbamazepina, na dose de 800 mg por dia. No segundo caso, o paciente apresentava dor excruciante, do tipo nevrálgico, do lado esquerdo da face, acompanhada de lacrimejamento, conjestão ocular, ptose palpebral parcial, rinorréia, fotofobia e fonofobia. A periodicidade dos surtos era de aproximadamente 12 meses. O exame neurológico revelou "zonas de gatilho" na primeira e segunda divisões do nervo trigêmeo. O paciente foi tratado com verapamil (160 mg/dia) e prednisona (60 mg/dia), com melhora da dor. A revisão da literatura mostrou o relato de 37 casos, divididos em dois grupos de pacientes. No primeiro grupo, os pacientes apresentavam surtos de cefaléia em salvas e nevralgia do trigêmeo ocorrendo em tempos diferentes. No segundo grupo, com apenas 9 casos, os quadros clínicos se sobrepõem do ponto de vista temporal, à semelhança dos casos aqui apresentados.

cafaléia em salvas; nevralgia do trigêmeo; síndrome da cefaléia em salvas - nevralgia do trigêmeo

Two patients with cluster-tic syndrome are reported. The first, a 43-years-old man, complaining of trigeminal pain in the right side of the face, accompanied by homolateral autonomic signs, such as ocular injection, sweating and drooped eyelid. The cluster attack was triggered by chewing, shaving and washing the face. The periodicity of bouts was six months. The pain was relieved by carbamazepine (800 mg/day). The second patient, a 43-year-old man, with an excruciant, neuralgic pain in the left side of the face, accompanied by tearing, conjuntival injection, drooped eyelid, rhinorrhea, photophobia and phonophobia. The neurologic examination showed triggered points in the first and second division of the trigeminal nerve. The patient was treated with verapamil (160mg/day) and prednisone (60 mg/day), with relief of his symptoms. The periodicity of bouts was once a year. The literature was reviewed and 37 cases previosly reported are considered. We conclude that there are two different groups of patients. In the first group, the patients had cluster and trigeminal bouts in different time. In the second group, with only nine cases, the patients presented both cluster and trigeminal type of pain at the same time, as in the two cases reported here.

Cluster-headache; trigeminal neuralgia; cluster-tic syndrome

Síndrome da cefaléia em salvas-nevralgia do trigêmeo: a propósito de dois casos

Cluster-Tic syndrome: two cases report

Paulo Hélio Monzillo^I; Wilson Luiz Sanvito^II; Mário Fernando Prieto Peres^III

^INeurologista

^IIProfessor Titular

^IIIAcadêmico de Medicina

RESUMO

São relatados dois casos da síndrome da cefaléia em salvas - nevralgia do trigêmeo. O primeiro caso, um paciente que apresentava crises do tipo trigeminal, do lado direito da face, acompanhadas de sinais autonômicos homolaterais do tipo lacrimejamento, coriza, congestão ocular, ptose palpebral parcial. As crises eram espontâneas ou desencadeadas por estímulos em "zonas de gatilho", com duração de segundos e numerosas ocorrências durante o dia. A periodicidade dos surtos era de aproximadamente 6 meses. Houve alivio dos sintomas quando da utilização de carbamazepina, na dose de 800 mg por dia. No segundo caso, o paciente apresentava dor excruciante, do tipo nevrálgico, do lado esquerdo da face, acompanhada de lacrimejamento, conjestão ocular, ptose palpebral parcial, rinorréia, fotofobia e fonofobia. A periodicidade dos surtos era de aproximadamente 12 meses. O exame neurológico revelou "zonas de gatilho" na primeira e segunda divisões do nervo trigêmeo. O paciente foi tratado com verapamil (160 mg/dia) e prednisona (60 mg/dia), com melhora da dor. A revisão da literatura mostrou o relato de 37 casos, divididos em dois grupos de pacientes. No primeiro grupo, os pacientes apresentavam surtos de cefaléia em salvas e nevralgia do trigêmeo ocorrendo em tempos diferentes. No segundo grupo, com apenas 9 casos, os quadros clínicos se sobrepõem do ponto de vista temporal, à semelhança dos casos aqui apresentados.

Palavras-chave: cafaléia em salvas, nevralgia do trigêmeo, síndrome da cefaléia em salvas - nevralgia do trigêmeo.

ABSTRACT

Two patients with cluster-tic syndrome are reported. The first, a 43-years-old man, complaining of trigeminal pain in the right side of the face, accompanied by homolateral autonomic signs, such as ocular injection, sweating and drooped eyelid. The cluster attack was triggered by chewing, shaving and washing the face. The periodicity of bouts was six months. The pain was relieved by carbamazepine (800 mg/day). The second patient, a 43-year-old man, with an excruciant, neuralgic pain in the left side of the face, accompanied by tearing, conjuntival injection, drooped eyelid, rhinorrhea, photophobia and phonophobia. The neurologic examination showed triggered points in the first and second division of the trigeminal nerve. The patient was treated with verapamil (160mg/day) and prednisone (60 mg/day), with relief of his symptoms. The periodicity of bouts was once a year. The literature was reviewed and 37 cases previosly reported are considered. We conclude that there are two different groups of patients. In the first group, the patients had cluster and trigeminal bouts in different time. In the second group, with only nine cases, the patients presented both cluster and trigeminal type of pain at the same time, as in the two cases reported here.

Key words: Cluster-headache, trigeminal neuralgia, cluster-tic syndrome.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 5-janeiro-1996.

Estudo realizado na Disciplina de Neurologia (Departamento de Medicina) da Faculdade de Ciências Médicas da Santa Casa de São Paulo.

Dr. Wilson L Sanvito - Disciplina de Neurologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo -Rua Cesário Motta Jr 112 - 01277-900 São Paulo SP - Brasil

1. Alberca R, Ochoa JJ. Cluster-tic. Neurology 1994;44:996-999.
2. Gruccu G, Leandri M, Feliciani M, Manfredi M. Idiopathic and syntomathic pain. J Neurol Neurosurg Pschiat 1990;53:1034-1042.
3. Hutchins LG, Lendri M, Feliciani M. Trigeminal neuralgia (tic doloreux): MR imaging assessment. Radiology 1990;175:837-841.
4. Klimek A, Harnsberger HR, Jacobs JM. Cluster-tic syndrome. Cephalalgia 1987;7:161-162.
5. Kunkel RS, Dohn DF. Surgical treatment of chronic migranous neuralgia. Clev Clin Q 1974;41:189-192.
6. Kunkle EC. Clues in tempos of cluster headache. Headache 1982;22:158-161.
7. Lance JW, Anthony M. Migranous neuralgia or cluster headache? J Neurol Sci 1971;13:401-414.
8. Levyman C, D'Agua AS Filho, Volpato MM. Epidermoid tumor of the fossa posterior causing multiple facial pain: a case report. Cephalalgia 1991;11:33-36.
9. Lye RH. Basilar artery ectasia: an unusual cause of trigeminal neuralgia. J Neurol Neurosurg Psychiat 1986;49:22-28.
10. Moskowitz MA. Basic mechanisms in vascular headache. Neurol Clin 1990;8:801-815.
11. Moskowitz MA. The visceral organ brain: implications for the pathophysiology of vascular head pain. Neurology 1991;41:182-186.
12. Olesen J. Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia 1988;8(Suppl. 7):1-96.
13. Sjaastad O, Saunte C, Salvesen R. Shortlasting unilateral neuralgiform headache attacks with conjunctival injection, tearing, sweating, and rhinorrhea. Cephalalgia 1989;9:147-156.
14. Solomon S, Apfebaum RI, Gugliemo KM. The cluster-tic syndrome and its therapy. Cephalalgia 1985;5:83-89.
15. Sutherland JM, Eadie MJ. Cluster headache. Res Clin Stud Headache 1972;3:92-125.
16. Watson P, Evans R. Cluster-tic syndrome. Headache 1985;25:123-126.

Datas de Publicação

Publicação nesta coleção
06 Dez 2010
Data do Fascículo
Jun 1996

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Alberca R, Ochoa JJ. Cluster-tic. Neurology 1994;44:996-999.

[2] 2. Gruccu G, Leandri M, Feliciani M, Manfredi M. Idiopathic and syntomathic pain. J Neurol Neurosurg Pschiat 1990;53:1034-1042.

[3] 3. Hutchins LG, Lendri M, Feliciani M. Trigeminal neuralgia (tic doloreux): MR imaging assessment. Radiology 1990;175:837-841.

[4] 4. Klimek A, Harnsberger HR, Jacobs JM. Cluster-tic syndrome. Cephalalgia 1987;7:161-162.

[5] 5. Kunkel RS, Dohn DF. Surgical treatment of chronic migranous neuralgia. Clev Clin Q 1974;41:189-192.

[6] 6. Kunkle EC. Clues in tempos of cluster headache. Headache 1982;22:158-161.

[7] 7. Lance JW, Anthony M. Migranous neuralgia or cluster headache? J Neurol Sci 1971;13:401-414.

[8] 8. Levyman C, D'Agua AS Filho, Volpato MM. Epidermoid tumor of the fossa posterior causing multiple facial pain: a case report. Cephalalgia 1991;11:33-36.

[9] 9. Lye RH. Basilar artery ectasia: an unusual cause of trigeminal neuralgia. J Neurol Neurosurg Psychiat 1986;49:22-28.

[10] 10. Moskowitz MA. Basic mechanisms in vascular headache. Neurol Clin 1990;8:801-815.

[11] 11. Moskowitz MA. The visceral organ brain: implications for the pathophysiology of vascular head pain. Neurology 1991;41:182-186.

[12] 12. Olesen J. Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia 1988;8(Suppl. 7):1-96.

[13] 13. Sjaastad O, Saunte C, Salvesen R. Shortlasting unilateral neuralgiform headache attacks with conjunctival injection, tearing, sweating, and rhinorrhea. Cephalalgia 1989;9:147-156.

[14] 14. Solomon S, Apfebaum RI, Gugliemo KM. The cluster-tic syndrome and its therapy. Cephalalgia 1985;5:83-89.

[15] 15. Sutherland JM, Eadie MJ. Cluster headache. Res Clin Stud Headache 1972;3:92-125.

[16] 16. Watson P, Evans R. Cluster-tic syndrome. Headache 1985;25:123-126.