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Cluster headache and arachnoid cyst.
Bengt Edvardsson1, Staffan Persson
1Department of Neurology, Faculty of Medicine, Skane University Hospital, S-221 85 Lund, Sweden.
Springerplus
|February 20, 2013
Summary
A rare case of cluster headache was triggered by a supra- and intrasellar arachnoid cyst. Neuroimaging is crucial for diagnosing secondary cluster headache, especially in late-onset cases, as surgical removal of the cyst resolved the patient's symptoms.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- Cluster headache is typically a primary headache disorder without identifiable structural pathology.
- Symptomatic cases of cluster headache, linked to conditions like tumors or malformations, are documented but challenging to diagnose.
- The evaluation and diagnosis of cluster headache remain an area requiring further clarification.
Purpose of the Study:
- To report a unique case of cluster headache secondary to a supra- and intrasellar arachnoid cyst.
- To emphasize the importance of neuroimaging in evaluating cluster headache, particularly in atypical or late-onset presentations.
- To highlight that arachnoid cysts can mimic primary cluster headache and resolve with surgical intervention.
Main Methods:
- A 43-year-old male patient presented with symptoms meeting the criteria for cluster headache.
- Initial diagnosis was cluster headache, with symptomatic treatment providing partial relief.
- Advanced neuroimaging, including CT and MRI, revealed a supra- and intrasellar arachnoid cyst causing mass effect.
Main Results:
- The patient's cluster headache attacks resolved completely following surgical removal of the arachnoid cyst.
- The patient remained headache-free during follow-up, suggesting a causal link between the cyst and the headache.
- Response to typical cluster headache medications does not rule out a secondary cause, as symptomatic cases can present similarly.
Conclusions:
- Neuroimaging, preferably contrast-enhanced MRI, is essential for all cluster headache patients, even with a normal neurological exam.
- Late-onset cluster headache warrants thorough investigation to exclude secondary causes.
- Supra- and intrasellar arachnoid cysts should be considered in the differential diagnosis of cluster headache.
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