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Dorsolateral medullary ischemic infarction causing autonomic dysfunction and headache: a case report.

Riccardo Altavilla1, Doriana Landi, Claudia Altamura

  • 1Neurologia Clinica, Università Campus Bio-Medico di Roma, Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, Rome, Italy. r.altavilla@unicampus.it

The Journal of Headache and Pain
|March 1, 2012
PubMed
Summary

Dorsolateral medullary ischemia can cause severe orbital pain and autonomic dysfunction. This case suggests hypothalamospinal tract involvement in headache presentations similar to trigeminal autonomic cephalalgia.

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Area of Science:

  • Neurology
  • Neuroscience
  • Vascular Neurology

Background:

  • Stroke is a cerebrovascular event that can manifest with diverse neurological symptoms.
  • Headache is a recognized, though less common, symptom of stroke.
  • Trigeminal Autonomic Cephalalgias (TACs) are a group of primary headache disorders characterized by unilateral head pain associated with autonomic features.

Observation:

  • A case study of a male patient presenting with severe orbital pain and autonomic dysfunction is detailed.
  • The patient's symptoms were found to be secondary to dorsolateral medullary ischemia, a type of stroke affecting the brainstem.
  • The specific location of the ischemic lesion was noted in relation to the observed symptomatology.

Findings:

  • The anatomical proximity of the dorsolateral medullary lesion to the hypothalamospinal tract is highlighted.
  • This suggests that the stroke-induced lesion may have impacted the hypothalamospinal pathways.
  • The resulting clinical presentation mimicked symptoms of trigeminal autonomic cephalalgia.

Implications:

  • This case provides insight into the neural pathways involved in autonomic dysfunction and headache.
  • It suggests a potential role for the hypothalamospinal tract in the pathogenesis of certain headache types, particularly those with autonomic features.
  • Understanding these mechanisms may aid in the diagnosis and management of stroke-induced headaches and TACs.