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Lack of efficacy and kidney microliths: case report A 33-year-old woman developed kidney microliths during treatment with topiramate for short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) syndrome. She also exhibited lack of efficacy during treatment with carbamazepine for the SUNCT syndrome [routes not stated]. The woman presented for the treatment of headaches. One month prior to the presentation, she started experiencing headaches with complaints of intense unilateral headache attacks at the forehead, brow and behind the eye, along with lacrimation at the pain side, rhinorrhoea, conjunctival redness and eyelid oedema lasted for 60–120s. No nausea, vomiting or light and sound phobia were noted during the attack. Initially, she experienced attacks once daily, but the frequency increased gradually. Treatment with unspecified painkillers, NSAIDs and triptans showed no significant relief. Hence, she visited a neurologist. Her indomethacin test showed a negative result. She also received treatment with carbamazepine 600 mg/day without any effect. No pathological findings were found. No family history of headaches and no abnormalities in the general neurological and somatic status were present. To rule out the possibility of secondary SUNCT syndrome, a brain and pituitary gland MRI was performed, which confirmed the diagnosis of Rathke’s cleft cyst. Her hormonal status showed increased levels of prolactin, while pituitary hormone levels were normal. Based on the findings, SUNCT syndrome was also suspected. Subsequently, she started receiving topiramate with a slow increase in the dosage to 75 mg/day. Her headache attacks reduced. Cabergoline was added to the treatment regimen for hyperprolactinaemia. Four months after the initiation of cabergoline, her prolactin level normalised. No increase in headache attacks was noted. Thereafter, cabergoline therapy was stopped. After a few months of topiramate treatment, her headache attacks completely resolved. During tapering of topiramate dosage, headache attacks returned. She received topiramate for 9 months; however, she developed kidney microliths due to the topiramate therapy [duration of treatment to reaction onset not stated]. Hence, the woman’s topiramate therapy was changed to lamotrigine [outcome not stated]. She received lamotrigine for additional 6 months. Four months after the discontinuation of lamotrigine, she started experiencing headaches once daily, which were clinically similar to the her previous condition. Her prolactin level also increased. Treatment with cabergoline was re-started, and her prolactin level normalised within a month. Her headaches also disappeared. No worsening of clinical symptoms was observed for a further three months. Makeeva T, et al. Secondary SUNCT Syndrome in a Patient with Rathke’s Cleft Cyst and Hyperprolactinemia: a Case Report. SN Comprehensive Clinical Medicine : 17 Oct 803514199 2020. Available from: URL: http://doi.org/10.1007/s42399-020-00581-w

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