Retro-ocular headache with autonomic features resembling “continuous” cluster headache in lateral medullary infarction

Headache is a common, although underemphasised, complaint of lateral medullary infarction. More than half of patients with posteroinferior cerebellar artery (PICA) infarcts develop headache. Fisher found headache in 22 out of 41 (54%) patients with lateral medullary infarction and, more recently, Kuwabara and Hirayama reported headache in 26 out of 34 (76%) patients with Wallenberg's syndrome.1 2 Less than 5% of patients with PICA infarcts, however, develop periocular, hemicranial headache and although sympathetic dysfunction in the form of Horner's syndrome, is a well known manifestation of lateral medullary infarction,1 2 signs of parasympathetic overactivity, such as lacrimation, eye injection, and nasal congestion, have never been described in lateral medullary infarction. Here we report on a patient with a lateral medullary infarction who developed anterior hemicranial pain accompanied by severe and persistent autonomic parasympathetic activation. This heavy smoking 37 year old man came to our hospital due to acute vertigo, lack of coordination of his left limbs, numbness in his right limbs, dysarthria, and dysphagia. An angiographic study performed in another hospital 3 months earlier due to intermittent claudication and decrease in left radial pulse had disclosed atherosclerotic changes in the lower …