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short-lasting unilateral neuralgiform headache attacks with cranial autonomic features secondary to meningioma of the left sphenoid wing, resected by transcigomatic approach
Author(s): ,
S. Solorio Pineda
Affiliations:
Centro Medico Lic. Adolfo Lopez Mateos, Neurocirugía, Toluca de Lerdo, Mexico
,
C.A. Tevera Ovando
Affiliations:
Centro Medico Lic. Adolfo Lopez Mateos, Neurocirugía, Toluca de Lerdo, Mexico
,
M.I. Ruiz Flores
Affiliations:
Centro Medico Lic. Adolfo Lopez Mateos, Neurocirugía, Toluca de Lerdo, Mexico
,
M.A. Vaca Ruiz
Affiliations:
Centro Medico Lic. Adolfo Lopez Mateos, Neurocirugía, Toluca de Lerdo, Mexico
,
R. Huato Reyes
Affiliations:
Centro Medico Lic. Adolfo Lopez Mateos, Neurocirugía, Toluca de Lerdo, Mexico
,
J. Ortega Espino
Affiliations:
Centro Medico Lic. Adolfo Lopez Mateos, Neurocirugía, Toluca de Lerdo, Mexico
,
A. Sosa Najera
Affiliations:
Centro Medico Lic. Adolfo Lopez Mateos, Neurocirugía, Toluca de Lerdo, Mexico
H. Martinez Maldonado
Affiliations:
Centro Medico Lic. Adolfo Lopez Mateos, Neurocirugía, Toluca de Lerdo, Mexico
EANS Academy. Solorio Pineda S. Oct 21, 2018; 225634; EP4085
Dr. Saul Solorio Pineda
Dr. Saul Solorio Pineda
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Abstract
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Female 63 years, hemicranial headache of 20 years of evolution, stabbing, intermittent with a frequency more than 30 times a day lasting 3 to 5 minutes, without predominance of schedule, accompanied by nausea, photophobia and sonophobia, without improvement with NSAIDs or with topiramate, with a small left eye sensation, lacrimation and nasal congestion. Left eye with 50/20 visual acuity, left hemifacial hyperesthesia, left hemifacial two-point discrimination, decreased conjunctival, corneal and maseterine reflex. In view of the patient´s lack of improvement with medical treatment, an MRI study of the brain was requested, where we observed an image at the level of the left sphenoid wing, an extra-axial tumor, heterogeneous with irregular and ill-defined borders of 60x67 mm, which enhances intensely to the administration of contrast medium.
Tumor lesion was resected by transcigomatic approach assisted by microscopy and guided by neuronavigation, degree of Simpson 3 resection and histopathological report of atypical meningioma, the patient was discharged without neurological deficit and with remission of trigeminal headache type SUNA.
Given the presentation of a long-standing autonomic trigeminal headache with poor response to medical treatment and in an elderly patient should be made differential diagnoses with neoplastic intracranial lesions such as pituitary tumors, paraselar, sphenoidal, tentorial, cervical high, trigeminal schwannoma among others.
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