继发于真菌性蝶窦炎的HC-tic 1例

A case report of hemicrania continua-tic syndrome due to fungus sphenoiditis

持续性偏侧头痛—三叉神经痛综合征(hemicrania continua-tic syndrome,HC-tic)临床罕见,现报道1例继发于真菌性蝶窦炎的HC-tic综合征。患者,男,78岁,右面部疼痛7月余,呈放电样、刀割样疼痛,突发突止,每次持续数秒。入院前3个月患者头痛呈持续性伴阵发性加重,发作时右侧面部潮红、右眼结膜充血、流泪、鼻塞、流涕。考虑HC-tic综合征,给予吲哚美辛治疗,完全缓解1周后再次加重。头颅CT检查示右侧蝶窦及筛窦炎,后行手术治疗。病检示霉菌性鼻窦炎,术后头痛症状完全缓解,随访6年未再复发。继发性HC-tic综合征在临床上既有三叉神经痛的表现,又有持续性偏侧头痛的特点,详细的病因筛查和针对性治疗是缓解头痛的关键。

Hemicrania continua-tic（HC-tic）syndrome is an uncommon disease.Now the study reported a case secondary to fungus sphenoiditis.A 78 years old man suffered right-side headache that had persisted for 7 months.Recurrent paroxysms of unilateral pain had the following characteristics：electric shock-like,stabbing or sharp,lasting for seconds.However,3 months before admission,the pain changed into a continuous pattern with a frequent fluctuation in the intensity.The exacerbations were accompanied with ipsilateral conjunctival injection,lacrimation,nasal congestion,rhinorrhoea and facial flushing.A diagnosis of HC-tic syndrome was made and indomethacin was taken.Nevertheless,complete response lasted only a week and headache became worse.Further CT scans of paranasal sinuses revealed the right sphenoid and ethmoid sinusitis.The patient was referred to E.N.T.department for surgical treatment.Histopathological examination suggested fungus nasosinusitis.In the next 6 years follow up,the headache never relapsed.Symptomatic HC-tic syndrome had the clinical features of both HC and trigeminal neuralgia.Thereby investigating the possible cause was necessary and etiological treatment was the key procedure to relieve pain.