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KMID : 0911820180190020078
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Korean Journal of Headache
2018 Volume.19 No. 2 p.78 ~ p.80
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Occipital Neuralgia Secondary to Focal Cerebral Subarachnoid Hemorrhage in Quadrigeminal Cistern
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Kim Geun-Soo
Cho Joong-Yang
Lee Jae-Jung
Park Hea-Ree
Song Pamela
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Abstract
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Occipital neuralgia presents as headache with extracranial pain. It can be attributed to multiple causes. The authors report the case of a 55-year-old man with right occipital neuralgia secondary to focal cerebral subarachnoid hemorrhage in quadrigeminal cistern. The patient reported paroxysmal sharp and lancinating pain in the right occipital region. The sensation was decreased in the affected area, and hypersensitivity to touch was also noted. He experienced pain relief soon after neuralgic pain medication with carbamazepine (200 mg/d). Seven days later the patient visited the emergency department for similar but more severe headache. The brain CT scan revealed focal subarachnoid hemorrhage. Further brain MRI and transfemoral cerebral angiography (TFCA) revealed arteriovenous malformation (AVM) located in the right cerebellum with a feeding aneurysm. The headache resolved after the onyx embolization of right cerebellum AVM and aneurysm. Thus, in the case of occipital pain, clinical suspicion for possible secondary causes are necessary.
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KEYWORD
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Occipital neuralgia, Cerebral subarachnoid hemorrhage
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