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Trigeminal autonomic cephalalgia-tic-like syndrome associated with a pontine tumour in a one year old girl
  1. J A van Vliet1,
  2. M D Ferrari1,
  3. J Haan1,
  4. L A E M Laan1,
  5. JHC Voormolen2
  1. 1Department of Neurology, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, Netherlands
  2. 2Department of Neurosurgery, Leiden University Medical Centre
  1. Correspondence to: Dr Laan;
 l.a.e.m.laan.neurology{at}lumc.nl

https://doi.org/10.1136/jnnp.74.3.391

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    The so called trigeminal autonomic cephalalgias (TAC) include episodic and chronic paroxysmal hemicrania (CPH), short lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT), and cluster headache (CH).1 Combinations of cluster headache and chronic paroxysmal hemicrania with trigeminal neuralgia have also been described and have been called cluster-tic syndrome2 or CPH-tic syndrome.3 In order to diagnose TACs, it is essential to record the case history carefully. Only rarely have intracranial lesions such as aneurysms or tumours been observed in association with TACs. In the majority of cases, no brain abnormalities are found using conventional imaging.

    We describe a three year old girl who suffered attacks of severe right sided temporal pain and autonomic disturbances and in addition neuralgic shooting pains associated with a pilocytic astrocytoma in the pons and medulla oblongata, extending to the upper cervical cord. The attacks disappeared once the tumour had been debulked.

    Case report

    A three year old girl presented with a history of extremely painful right sided temporal headache attacks since the age of one year. During these attacks she would grab her right ear and cry intensely. Her …

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    Footnotes

    • Competing interests: none declared

    • A video recording of the patient during a headache attack is available on the journal website (www.jnnp.com). The recording shows the patient sitting still with a swollen eyelid on the right side. A few moments later she suddenly starts to cry intensely, while grabbing to her right eye and right ear. During this episode, she moves back and forth, and pronounced lacrymation is seen in her right eye.