SUNCT like syndrome preceding acute ophthalmic- distribution zoster: A case report and review of the literature.

BACKGROUND: SUNCT like syndrome has been observed as a post zoster condition, as a syndrome associated with overt ophthalmic zoster after appearance of herpetic lesions and in varicella zoster virus meningoencephalitis without rash. However, SUNCT like syndrome fully consistent and congruent with the criteria of the ICHD immediately before onset of an ophthalmic-distribution zoster has not been reported.

CASE PRESENTATION: We report 73-year-old patient with a SUNCT like syndrome as the first presentation of an acute ophthalmic-distribution zoster. Symptomatic treatment was highly effective, after antiviral treatment with acyclovir no further medication was required.

CONCLUSIONS: SUNCT like syndrome can be the initial clinical presentation immediately preceding an acute ophthalmic-distribution zoster. This is congruent with previous observations of zoster - related SUNCT like syndromes with different temporal relationship to zoster. Zoster - related SUNCT like syndromes seem to respond well to symptomatic treatment. Clinicians should ask and look for history and signs of ophthalmic zoster in SUNCT like headaches.