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Trigeminal Autonomic Cephalalgias Manifested As The Only Initial Symptom Of Ehlers–Danlos Syndrome Type IV

Authors Chen MJ, Li HF, Mao S

Received 6 June 2019

Accepted for publication 6 November 2019

Published 27 November 2019 Volume 2019:12 Pages 3215—3220

DOI https://doi.org/10.2147/JPR.S218580

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Michael A Überall


Mei-Jiao Chen, Hong-Fu Li, Shanying Mao

Department of Neurology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

Correspondence: Shanying Mao; Hong-Fu Li
Department of Neurology, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China
Email shanyingm@163.com; hongfuli@zju.edu.cn

Abstract: Ehlers–Danlos syndrome (EDS) type IV is characterized by thin skin with visible veins, easy bruising, characteristic facial features, arterial and digestive complications, as well as rupture of the gravid uterus. It has never been previously reported that trigeminal autonomic cephalalgias (TACs) could manifest as the only initial symptom of EDS type IV. Here, we report a case of a 27-year-old man who presented atypical headache like TACs stimulated by right internal carotid artery dissection. About one month after his discharge, he suffered dissection of the right renal artery and splenic artery, in addition to partial infarction of the right kidney and spleen. Genetic testing revealed a novel splicing variant c.799-1G>A within COL3A1. He was ultimately diagnosed with Ehlers–Danlos syndrome type IV. This case expanded the genetic spectrum and clinical manifestation of EDS type IV and provided a significant implication for the diagnosis of EDS type IV when the initial symptom manifested as TACs, not the typical presentation of EDS type IV.

Keywords: trigeminal autonomic cephalalgias, internal carotid artery dissection, Ehlers–Danlos syndrome, whole exome sequencing, Sanger sequencing


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