ABSTRACT
Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) syndrome is a rare form of primary headache disorder, although secondary causes, particularly posterior fossa abnormalities, are well known. We report a case of SUNCT syndrome secondary to a prolactinoma. Administration of dopamine agonists led to complete resolution of the SUNCT attacks. This case, together with other similar case reports in the literature, highlight the importance of excluding a diagnosis of pituitary adenoma in all suspected cases of SUNCT syndrome, especially as the headache can precede more classical pituitary symptoms by a considerable period of time. Clinicians managing patients with suspected SUNCT syndrome should elicit a history of symptoms associated with pituitary neoplasms, perform a magnetic resonance imaging scan of the brain and pituitary, and screen for serum hormonal abnormalities.
Subject(s)
Adenoma/complications , Conjunctival Diseases/etiology , Headache/complications , Headache/etiology , Pituitary Neoplasms/complications , Prolactinoma/complications , Adenoma/diagnosis , Adenoma/pathology , Adult , Conjunctival Diseases/pathology , Diagnosis, Differential , Humans , Magnetic Resonance Imaging , Male , Pituitary Neoplasms/diagnosis , Pituitary Neoplasms/pathology , Syndrome , Tears/metabolismABSTRACT
The tick responsible for Lyme disease is common in areas inhabited by deer. This should theoretically put military personnel at increased risk. A history of tick bite is uncommon and the characteristic skin rash often absent. Two examples of servicemen with neurological Lyme disease without cutaneous manifestations are discussed, and six other cases referred to the RAF Institute of Pathology and Tropical Medicine since 1987 briefly reviewed. Five of the cases contracted the disease in Germany and four were dependents. Lyme disease is under-recognised and under-reported, so that the scale of the problem cannot be determined. It is recommended that wooded areas inhabited by deer should not be frequented without adequate clothing, particularly in the early summer months when tick activity is at its greatest.
Subject(s)
Lyme Disease/diagnosis , Military Personnel , Nervous System Diseases/microbiology , Adult , Germany , Humans , Lyme Disease/epidemiology , Male , Middle Aged , Military Personnel/statistics & numerical data , Nervous System Diseases/diagnosis , Serologic Tests , United KingdomABSTRACT
For 30 years the Royal Air Force has used the EEG as part of the medical screening of candidates for aircrew training. A total of 13,658 males aged 17-25 years have been examined. None had a previous history of significant illness. Sixty-nine (0.5%) of these showed unequivocal epileptiform discharges, 44 (58%) occurring only on photic stimulation. Those with EEG discharges of uncertain significance such as 6 and 14 Hz positive spikes, 6 Hz spike and wave, and non-specific paroxysmal activity were not included. A group of 43 with a follow-up period of 5-29 years have been reviewed. Only one person developed unequivocal epilepsy. If this rate is combined with results from similar studies, the chance of healthy individuals with EEG abnormalities of this type subsequently developing epilepsy is 2-3%.
