1/205. Posterior epidural migration of sequestered lumbar disc fragments. Report of two cases.The posterior epidural migration of sequestered lumbar disc fragments is an uncommon event. The authors report two such cases in which patients presented with either intense radicular pain or cauda equina syndrome. The radiological characteristics were the posterior epidural location and the ring enhancement of the mass after injection of contrast material. The major diagnostic pitfalls are discussed.- - - - - - - - - - ranking = 1keywords = contrast (Clic here for more details about this article) |
2/205. hyperalgesia with reduced laser evoked potentials in neuropathic pain.Nociceptive evoked potentials to laser stimuli (LEPs) are able to detect lesions of pain and temperature pathways at peripheral, spinal and supraspinal levels. It is commonly accepted that LEP attenuation correlates with the loss of pain and temperature sensations, while pathological heat-pain hypersensitivity has been associated with increased LEP amplitude. Here we present two patients in whom increased pain sensation (hyperalgesia) to laser stimuli was, on the contrary, associated to delayed, desynchronized and attenuated LEPs. Both patients experienced increased unpleasantness and affective reactions to laser, associated to poor ability to localize the stimulus. In both cases the results may be explained by an overactivation of the 'medial pain system', in one patient due to deafferentation of cortical sensory areas by a capsular lesion, and in the other to imbalance between A-delta and C fiber excitation due to peripheral nerve injury. Our results suggest that LEPs, as currently recorded, reflect the activity of a 'lateral' pain system subserved by rapidly conducting fibers. They may therefore, assess the sensory and cognitive dimensions of pain, but may not index adequately the affective-emotional aspects of pain sensation conveyed by the 'medial' pain system. The dissociation between pain sensation and cortical EPs deserve to be added to the current semiology of LEPs, as the presence of abnormal pain to laser on the background of reduced LEPs substantiates the neuropathic nature of the pain.- - - - - - - - - - ranking = 4.3794570413578keywords = sensitivity (Clic here for more details about this article) |
3/205. Central pain as a manifestation of partial epileptic seizures.Central pain of epileptic etiology is very rare. The frequency of painful sensations in epileptic seizures varies between 0.3 and 2.8%. We report a patient with short-lasting painful attacks in the right arm. Changes in the electroencephalography (EEG) and the effective treatment with anticonvulsants in contrast to the therapeutic failure of analgesics, lead to the diagnosis of partial epilepsy with painful seizures. magnetic resonance imaging (MRI) of the brain was normal, whereas a postcentral parietal site of seizure origin involving the secondary somatosensory area was suggested by electroencephalographic findings. The literature is reviewed for cases with pain as the sole or predominant symptom of epileptic seizures.- - - - - - - - - - ranking = 1keywords = contrast (Clic here for more details about this article) |
4/205. hypnosis: an alternative in pain management for nurse practitioners.hypnosis and the trance phenomenon is an age-old tool for the treatment of a variety of conditions, including pain. Medically accepted for over 50 years as a legitimate therapy, research continues into its mechanisms and actions. In this article, its origins, history, theoretical basis, and various uses are discussed. Case presentations from the author are provided, showing its use for a variety of pain management scenarios. Sample hypnotic scripts allow the reader to better visualize the applicability of hypnotic suggestion to general inductions and pain management. References are provided for individuals seeking further information and/or training in hypnosis.- - - - - - - - - - ranking = 0.62285265100905keywords = visual (Clic here for more details about this article) |
5/205. magnetic resonance imaging evaluation of heel pain.magnetic resonance imaging is superior to radiographic and scintigraphic examination for pathologic evaluation of the musculoskeletal system. magnetic resonance imaging demonstrates increased sensitivity and specificity compared with radiographic evaluation, and equal sensitivity and increased specificity compared with scintigraphic examination. Two case studies of magnetic resonance imaging evaluation of heel pain involving a calcaneal stress fracture and a capillary hemangioma are presented.- - - - - - - - - - ranking = 8.7589140827157keywords = sensitivity (Clic here for more details about this article) |
6/205. Recurrent steroid-responsive trismus and painful ophthalmoplegia.A 63-year-old woman experienced two episodes of trismus and painful ophthalmoplegia at an interval of six years. She suffered left visual loss, and enhanced CT scan and MR imaging revealed heterogeneous enlargement of the left extraocular muscles extending to the orbital apex. In addition, the left pterygopalatine fossa was filled with a mass isointense with muscle without evidence of surrounding tissue invasion; 67Ga scintigraphy showed high uptake in this lesion. Steroid administration dramatically resolved the trismus, and the mass in the orbit and extraorbit vanished completely. orbital pseudotumor is characterized by self-limited, relapsing, steroid-responsive painful ophthalmoplegia, and this case could be a variant of this entity with inflammation extending into the extraorbital area.- - - - - - - - - - ranking = 0.62285265100905keywords = visual (Clic here for more details about this article) |
7/205. upper extremity pain of 10 years duration caused by a glomus tumor.BACKGROUND AND OBJECTIVES: Long-standing limb pain typically has a multifactorial etiology not amenable to causal therapy. We present a case of chronic progressing upper extremity pain caused by a glomus tumor; the excision was curative. methods: A 39-year-old woman presented with 10-year history of constant deep internal throbbing, aching pain localized to the radial aspect of the left index finger and additional intermittent shooting pains radiating up the arm toward the shoulder. Pain was increased after minor local trauma, following cold exposure, and for unknown reasons. A blotchy, bluish skin discoloration could appear on the radial aspect of the index finger during severe pain. Nonsteroidal antinflammatory drugs, narcotics, amitriptyline, local heat, bracing, and a sympathetic nerve block had all been ineffective. The physical examination was characterized by exquisite pressure tenderness over the radial aspect of the left index finger, most pronounced just distal to the distal interphalengeal joint. RESULTS: Inflation of a left arm blood pressure cuff to above systolic pressures abolished pain. A glomus tumor was suspected and confirmed by histologic examination. CONCLUSIONS: Glomus tumors are rare, benign neoplasms (1 to 5% of all hand tumors), developing from neuromyoarterial glomus bodies. They usually present with pain and may mimic other painful conditions, delaying the average time until diagnosis for up to 10 years. The classic diagnostic triad consists of local pain, pressure tenderness, and cold hypersensitivity. Abolition of pain following inflation of a blood pressure cuff to above systolic levels (ischemia test) is highly diagnostic. We suggest routine use of this test in cases of upper limb pain of unclear etiology.- - - - - - - - - - ranking = 4.3794570413578keywords = sensitivity (Clic here for more details about this article) |
8/205. Pitfall: a pseudo tumor within the left liver lobe presenting with abdominal pain, jaundice and severe weight loss.A 51 year old male patient with a history of chronic alcohol consumption and recurrent pancreatitis was referred to our hospital with jaundice, epigastric pain, severe diarrhoea and weight loss of 28 kg within the last 12 months. A CT scan of the abdomen 4 months before admission had shown a pancreatitis with free fluid around the corpus and tail of the pancreas as well as dilated intrahepatic bile ducts and a cavernous transformation of the portal vein. Moreover, a tumor (3.5 x 3.0 x 3.6 cm) with irregular contrast enhancement was seen within the left liver lobe. The patient was referred to us for further evaluation and treatment. The initial B-Mode sonogram revealed a bull's eye like well defined lesion (8.1 x 7.5 x 7.0 cm) within the left liver lobe, consistent with a tumour or abscess. Prior to a diagnostic needle biopsy a PTCD was performed in this case presenting with dilated intrahepatic bile ducts and having a history of Billroth II operation. An additional colour coded Duplex Doppler ultrasonography demonstrated a visceral artery aneurysm and prevented us from performing the diagnostic puncture. The aneurysm was assumed to originate from a variant or a branch of the left hepatic artery. angiography revealed a pseudoaneurysm of the pancreaticoduodenal artery and coil embolization was performed because of the increasing size and the risk of a bleeding complication. Postinterventional colour duplex ultrasound measurement showed no blood flow within the aneurysm. Retrospectively, the pseudoaneurysm must have led to a compression of the common bile duct, since the patient did not develop cholestasis after embolization and removal of the PTCD. Thus, a pseudoaneurysm of the pancreaticoduodenal artery must be included in the differential diagnosis of liver tumours in patients with chronic pancreatitis, despite its unusual localization near the liver. Therefore, we suggest that colour coded ultrasonography should be applied to any unclear, bull's eye like lesion, even though this method alone cannot exactly determine the origin of the pseudoaneurysm. Interventional angiography remains the gold standard for the diagnosis and therapy of visceral artery aneurysm.- - - - - - - - - - ranking = 1keywords = contrast (Clic here for more details about this article) |
9/205. A sighting of orbital pseudotumor.A 39-year-old woman developed bilateral proptosis, photophobia, and pain with extraocular movements over the course of 5 days. Her findings initially were ocular pain and photophobia which progressed to periorbital edema and nasal discharge ultimately resulting in proptosis with vertical globe displacement and decreased visual acuity. She was diagnosed with corneal abrasion and sinusitis respectively during two initial emergency department visits. On her third visit to the emergency department within 4 days, she developed acute visual deficits. The patient was subsequently diagnosed with orbital pseudotumor after computed tomography scan revealed inflammation of orbital structures bilaterally.- - - - - - - - - - ranking = 1.2457053020181keywords = visual (Clic here for more details about this article) |
10/205. drug-seeking behavior in urolithiasis in the noncontrast computed tomography era: 2 cases.Symptomatic urolithiasis is usually treated with narcotic pain management. This leads to the potential for use of its symptoms for personal gain. Historically, the typical presentation of a narcotic-seeking "stone patient" was a history of radiolucent stones and an intravenous contrast allergy. With the increased use of non-contrast-enhanced computed tomography to evaluate patients suspected of having acute urolithiasis, we have seen a change in the strategy of narcotic-seeking patients. We report 2 patients with pelvic calcifications on non-contrast-enhanced computed tomography feigning symptoms of urolithiasis to receive narcotic drugs.- - - - - - - - - - ranking = 7keywords = contrast (Clic here for more details about this article) |
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