1/31. Painful oculomotor nerve palsy - A presenting sign of internal carotid artery stenosis.We report a 72-year-old patient presenting acute painful partial left IIIrd nerve palsy with pupillary involvement. Due to the patient's age and mild hyperlipidemia a microangiopathic ischemic origin was assumed after a compressive or inflammatory cause had been excluded by magnetic resonance imaging, blood and cerebrospinal fluid analyses. Carotid ultrasound examination disclosed a high-grade stenosis of the ipsilateral internal carotid artery (ICA). In the absence of diabetes mellitus, other significant vascular risk factors and leukoencephalopathy indicative of advanced arteriosclerotic disease, we suggest a pathogenetic role of the ICA stenosis in ischemic IIIrd nerve palsy. The frequency of a IIIrd nerve palsy as the presenting symptom in patients with ICA stenosis as well as the frequency of an ICA stenosis being the cause in patients with isolated IIIrd nerve palsy is not well documented in the literature. Both seem to be rare but may be underestimated. We advocate cervicocerebral ultrasound examination in patients presenting IIIrd nerve palsy with no obvious or a presumed ischemic cause.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
2/31. Glossopharyngeal neuralgia referred from a pontine lesion.Paroxysmal pain in the form of glossopharyngeal neuralgia is less frequent and less well understood than that of trigeminal neuralgia. Diagnostic confusion can arise especially when both conditions occur in the one patient. We report a patient with a 20-year history of left-sided glossopharyngeal neuralgia with trigger zones in both the trigeminal and glossopharyngeal dermatomal distributions. magnetic resonance imaging revealed a single T2-weighted hyperintense signal in the left pons with no other abnormality. It is postulated that ephaptic transmission between central pain fibers and the trigeminal or glossopharyngeal fibers, which both enter the spinal trigeminal tract, resulted, respectively, in conventional and "referred" glossopharyngeal neuralgia.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
3/31. Analgesic effect of oral ketamine in chronic neuropathic pain of spinal origin: a case report.ketamine is an injectable anesthetic induction agent that has been reported to have analgesic activity in pain from a variety of mechanisms, but predominantly in neuralgic and dysesthetic neuropathic pain. In this case report we illustrate the effectiveness of ketamine in a patient with neuropathic pain resulting from cauda equina trauma. Among the issues addressed are the role of pretreatment with haloperidol to prevent ketamine-induced psychomimetic effects, the potential for fewer side effects and a need for lower doses when ketamine is administered orally, and the need for further study regarding appropriate monitoring parameters during the titration phase. Oral ketamine can be effective in treatment refractory chronic neuropathic pain of spinal origin.- - - - - - - - - - ranking = 5keywords = spinal (Clic here for more details about this article) |
4/31. Responses to median and tibial nerve stimulation in patients with chronic neuropathic pain.Somatosensory evoked magnetic fields and electrical potentials were measured in eight patients with unilateral neuropathic pain. After median nerve stimulation on the painful side, the amplitudes of the evoked responses were enhanced 2 to 3 times at a latency of about 100 ms compared to the responses of the contralateral, unaffected side. After posterior tibial nerve stimulation an enhancement was found at latencies around 110 ms and 150 ms. The scalp distribution of the magnetic field at the latencies of "abnormal" responses was dipolar and the responses could be ascribed to a current dipole. Three (of the eight) patients underwent spinal cord stimulation (SCS) for their pain. The enhancement of the evoked responses to stimulation of the painful side decreased after spinal cord stimulation. After a long period of spinal cord stimulation only (e.g., a year) during which the patient reported to be pain free, these "abnormal" responses were no longer observed.- - - - - - - - - - ranking = 3keywords = spinal (Clic here for more details about this article) |
5/31. morphine-induced ventilatory failure after spinal cord compression.We describe a patient who required large doses of parenteral morphine for severe pain secondary to epidural spinal cord compression caused by metastatic cancer. The pain improved suddenly after neurological progression to a complete cord compression. Shortly afterwards, the patient developed acute respiratory depression caused by an apparent relative overdose of morphine. Our hypothesis is that the cord compression relieved the pain by interrupting the nociceptive pathway. The dose of morphine was then physiologically excessive once the neurologic damage was completed and the pain had been relieved. We advise caution in patients receiving high doses of opioids in which a change in disease status or a pain-relieving intervention may produce rapid pain relief.- - - - - - - - - - ranking = 5keywords = spinal (Clic here for more details about this article) |
6/31. The value of MR neurography for evaluating extraspinal neuropathic leg pain: a pictorial essay.SUMMARY: Fifteen patients with neuropathic leg pain referable to the lumbosacral plexus or sciatic nerve underwent high-resolution MR neurography. Thirteen of the patients also underwent routine MR imaging of the lumbar segments of the spinal cord before undergoing MR neurography. Using phased-array surface coils, we performed MR neurography with T1-weighted spin-echo and fat-saturated T2-weighted fast spin-echo or fast spin-echo inversion recovery sequences, which included coronal, oblique sagittal, and/or axial views. The lumbosacral plexus and/or sciatic nerve were identified using anatomic location, fascicular morphology, and signal intensity as discriminatory criteria. None of the routine MR imaging studies of the lumbar segments of the spinal cord established the cause of the reported symptoms. Conversely, MR neurography showed a causal abnormality accounting for the clinical findings in all 15 cases. Detected anatomic abnormalities included fibrous entrapment, muscular entrapment, vascular compression, posttraumatic injury, ischemic neuropathy, neoplastic infiltration, granulomatous infiltration, neural sheath tumor, postradiation scar tissue, and hypertrophic neuropathy.- - - - - - - - - - ranking = 6keywords = spinal (Clic here for more details about this article) |
7/31. Extraforaminal, thoracic, epidural cavernous haemangioma: case report with analysis of magnetic resonance imaging characteristics and review of the literature.BACKGROUND: A case of a solitary, thoracic, extradural, extraforaminal cavernous haemangioma causing a chronic neuralgia syndrome is presented. In the spectrum of spinal axis cavernous malformations, extradural lesions are exceedingly rare. A purely extraforaminal, paraspinal cavernous haemangioma has never been previously reported. METHOD: A 56-year-old woman suffered from a chronic neuralgia syndrome at the right D3 dermatome. Conservative treatment was ineffective. MRI revealed an extraforaminal mass at T3-4 which homogeneously enhanced after gadolinium administration mimicking a schwannoma. The lesion was completely removed via an extraforaminal approach. FINDINGS: Histopathological investigation revealed a cavernous haemangioma. The patient recovered completely within 4 weeks after surgery. Interpretation: Cavernous haemangiomas are developmental vascular hamartomas representing a single entity regardless of their location. As purely epidural lesions are rare, their clinical and radiological presentation could be confusing if located foraminally or extraforaminally. Thus, their signal characteristics providing valuable information will facilitate diagnosis and treatment.- - - - - - - - - - ranking = 2keywords = spinal (Clic here for more details about this article) |
8/31. Examination of the variations of lateral femoral cutaneous nerves: report of two cases.The origins, courses and relations of lateral femoral cutaneous nerves (LFCNs) were examined bilaterally in 28 cadavers, and the variations were observed in two. On the right side of one cadaver, the ventral rami of the first and second lumbar spinal nerves were united and then this nerve was divided into four branches. From medial to lateral, these branches were the obturator nerve, the femoral nerve, the medially located LFCN and the laterally located LFCN. On the left side of another cadaver, there were three LFCNs. All of these nerves pierced the psoas major muscle anterolaterally. Two of these nerves, which pierced the psoas major muscle more proximally than the third, united with each other by a communicating branch anterior to the iliacus muscle. These types of variations are very important, especially in the presence of paresthesias or pain in the anterior thigh, lateral thigh and gluteal region. In these cases, surgeons must always remember the possible variations of the LFCN during surgical procedures in order to prevent injury and the occurrence of meralgia paresthetica.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
9/31. Iatrogenic acute spinal epidural abscess with septic meningitis: MR findings.A contaminated catheter used in epidural anesthesia in a 71-year-old female produced acute epidural abscess and septic meningitis. methicillin-resistant staphylococcus aureus (MRSA) was detected in a culture of the epidural pus. Both T1- and T2-weighted MR images showed low intensity mass lesion compressing the thecal sac behind the vertebral body L3. The low intensity lesion was probably pus with gas component. In these low intensity lesions in MR findings with gas component, MR was superior to myelography because it visualized both the degree of compression to the thecal sac and extension of the lesion in all directions.- - - - - - - - - - ranking = 4keywords = spinal (Clic here for more details about this article) |
10/31. Pharmacologic management part 2: lesser-studied neuropathic pain diseases.This second part of a review of the pharmacologic management of neuropathic pain diseases describes the current treatment options for three lesser-studied neuropathic syndromes: Central poststroke pain, spinal cord injury, and complex regional pain syndrome II. diagnosis can be difficult in patients with these syndromes, because the pain experienced is much greater and of a different type than would normally be expected following a stroke or injury to the spinal cord or a peripheral nerve. Even when an accurate and timely diagnosis is made, treatment options are limited and frequently suboptimal. However, the results of published trials do support the use of anticonvulsants and/or tricyclic antidepressants as first-line pharmacotherapy in these three neuropathic pain syndromes. To maximize treatment outcomes, future research must: Continue to more fully elucidate the relationship between the signs and symptoms of pain and the underlying pathophysiology; Delineate the natural history of central poststroke pain, spinal cord injury, and complex regional pain syndrome; Identify patient-related factors that may indicate an increased risk of developing neuropathic pain following stroke or nerve injury; Investigate emerging treatments that target underlying pain mechanisms.- - - - - - - - - - ranking = 3keywords = spinal (Clic here for more details about this article) |
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