This would be considered SUNCT secondary to viral encephalomyelitis
as any headache in the context of an infection should be attributed to the infection per IHS 3rd edition .
Microscopically in all animals, the lesions were pathognomonic for a highly neurotropic viral encephalomyelitis
and included moderate to marked lymphocytic cell perivascular cuffing and neuronal and ganglionic degeneration and necrosis, with microgliosis but minimal meningitis, especially in the dorsal and ventral horns of the spinal cord gray matter and multifocally in the medulla oblongata, cerebellar peduncles, and midbrain (Figure 3).
Although the exact pathogenesis is unknown, it is likely that both a direct, vaccinia-associated acute viral encephalomyelitis
and an autoimmune-mediated inflammatory reaction resulting in postvaccination demyelination (acute disseminated encephalomyelitis [ADEM]) occur (6).
The patient was intubated and transferred to the National Children's Hospital with a diagnosis of viral encephalomyelitis
. His severe central nervous system involvement progressed to coma in <24 h with muscle hypotonia.