A patient with red dot on the forehead

A 32-year old woman presented with red dot on her forehead and eyelid ecchymosis

Teaching NeuroImagesNeurology

Resident & Fellow Section

© 2015 American Academy of Neurology

Vignette

• A-32-year-old woman with complaint of episodic headaches presented with one and half month of continuous left frontotemporal headache, pain and dragging sensation in left eye.

• Red forehead dot was noted along with eyelid ecchymosis.• Family history of migraine was reported in patient’s father

and grandmother. • Neurological examination, MRI brain, MRA and MRV of

brain were normal and work-up revealed no evidence for vasculitis.

© 2015 American Academy of Neurology Sethi PK et al.

Imaging

© 2015 American Academy of Neurology Sethi PK et al.

Imaging

© 2015 American Academy of Neurology Sethi PK et al.

Red forehead dot syndrome and migraine revisited

• Likely cause of red forehead dot in the patient reported is migraine.

• Autonomic nervous system dysfunction has been reported in migraine and orthostatic hypotension has been reported to

be more common in migraineurs.

• Activation of the trigeminovascular system leading to release of vasoactive peptides such as nitric oxide and substance P is the likely cause of the red forehead dot, eyelid ecchymosis as well as red ear syndrome (RES) in some migraine patients.

© 2015 American Academy of Neurology Sethi PK et al.