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Bethamcharla R, Abou-Al-Shaar H, Maarbjerg S, Chang YF, Gacka CN, Sekula RF. Percutaneous glycerol rhizolysis of the trigeminal ganglion for the treatment of idiopathic and classic trigeminal neuralgia: Outcomes and complications. Eur J Neurol 2023; 30:3307-3313. [PMID: 37422922 DOI: 10.1111/ene.15977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/23/2023] [Accepted: 07/04/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND AND PURPOSE Patients with idiopathic trigeminal neuralgia (TN) with absent arterial contact or venous contact only and classic TN with morphological changes of the trigeminal nerve secondary to venous compression are not routinely recommended microvascular decompression at our institution. In patients with these anatomical subtypes of TN, limited data exists describing the outcomes of percutaneous glycerol rhizolysis (PGR) of the trigeminal ganglion (TG). METHODS We performed a retrospective single-center cohort study and analyzed outcomes and complications after PGR of the TG. Clinical outcome after PGR of the TG was assessed via the Barrow Neurological Institute (BNI) Pain Scale. RESULTS Forty-five patients underwent a total of 66 PGRs of the TG. At short-term follow-up, 58 procedures (87.9%) resulted in a BNI score of I (i.e., freedom from pain without medication). At a median follow-up of 3.07 years, 18 procedures (27.3%) resulted in a BNI score of I, 12 procedures (18.1%) resulted in BNI score of IIIa, and 36 procedures (54.5%) resulted in a BNI score of IIIb-V. The median length of freedom from pain without medication was 1.5 years. Eighteen procedures (27.3%) caused hypesthesia and two (3.0%) caused paresthesias. There were no serious complications. CONCLUSION In patients with these anatomical subtypes of TN there was a high rate of short-term pain relief for the first 1-2 years and thereafter a large proportion of patients experienced pain relapse. In this patient group, PGR of the TG represents a safe procedure that is efficacious in the short term.
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Affiliation(s)
- Raviteja Bethamcharla
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA
| | - Hussam Abou-Al-Shaar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Stine Maarbjerg
- Danish Headache Centre, Department of Neurology, Glostrup Hospital, University of Copenhagen, Glostrup, Denmark
| | - Yue-Fang Chang
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Caroline N Gacka
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA
| | - Raymond F Sekula
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA
- Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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Alokaili H, Hanawi M, Aldaker F, Alokaili Y, Alfaraj Z, Bhat TA, Aljasir A. Dysmenorrhea Heat Therapy Injury in a Post-Abdominoplasty Patient: A Case Report. Cureus 2023; 15:e40169. [PMID: 37431335 PMCID: PMC10329779 DOI: 10.7759/cureus.40169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2023] [Indexed: 07/12/2023] Open
Abstract
The anterolateral abdominal wall has rich neurosensory innervation from many sensory nerves, and in abdominoplasty surgical procedures, these nerves are invariably cut, resulting in anesthesia or hypoesthesia in their respective territories. Here we report a 26-year-old healthy female post-abdominoplasty patient who sustained an incidental contact burn injury from a common home remedy for her menstrual pain. Fortunately, the burn healed with secondary intent. Post-surgical loss of protective sensation facilitated this injury from heat therapy for spasmodic dysmenorrhea. Therefore, the patients planned for abdominoplasty should be informed in advance about the possibility of the development of this complication with its associated sequelae and its prevention. Early recognition of this surgical complication and timely intervention will prevent the consequent disfiguring of the rejuvenated abdominal wall.
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Affiliation(s)
- Hesham Alokaili
- Department of Plastic and Reconstructive Surgery, King Saud Medical City, Riyadh, SAU
| | - Maha Hanawi
- Department of Plastic and Reconstructive Surgery, King Saud Medical City, Riyadh, SAU
| | - Fatima Aldaker
- Department of Plastic and Reconstructive Surgery, King Saud Medical City, Riyadh, SAU
| | - Yara Alokaili
- College of Medicine, Alfaisal University, Riyadh, SAU
| | - Zainab Alfaraj
- College of Medicine, Dar Al Uloom University, Riyadh, SAU
| | - Tanveer A Bhat
- Department of Plastic and Reconstructive Surgery, King Saud Medical City, Riyadh, SAU
| | - Anas Aljasir
- Department of Plastic and Reconstructive Surgery, King Saud Medical City, Riyadh, SAU
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3
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Imaizumi U, Beppu S, Sanuki T. Treatment of unexplained facial numbness with stellate ganglion blockade: A case report. Clin Case Rep 2023; 11:e6871. [PMID: 36698517 PMCID: PMC9850849 DOI: 10.1002/ccr3.6871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/25/2022] [Accepted: 01/02/2023] [Indexed: 01/21/2023] Open
Abstract
To date, there is no established treatment for facial numbness or dysesthesia of unspecified causes. Herein, we report a case of unexplained facial numbness and confirmed hypesthesia that achieved clinical response to stellate ganglion blockade (SGB). SGB might be an effective treatment of psychological stress-related facial numbness of unknown origin.
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Affiliation(s)
- Uno Imaizumi
- Department of Dental AnesthesiologyKanagawa Dental UniversityYokosukaKanagawaJapan
| | - Satoshi Beppu
- Department of Dental AnesthesiologyKanagawa Dental UniversityYokosukaKanagawaJapan
| | - Takuro Sanuki
- Department of Dental AnesthesiologyKanagawa Dental UniversityYokosukaKanagawaJapan
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Bedrouni M, Touma L, Sauvé C, Botez S, Soulières D, Forté S. Numb Chin Syndrome in Sickle Cell Disease: A Systematic Review and Recommendations for Investigation and Management. Diagnostics (Basel) 2022; 12:diagnostics12122933. [PMID: 36552940 PMCID: PMC9776680 DOI: 10.3390/diagnostics12122933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/15/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022] Open
Abstract
Numb chin syndrome (NCS) is a rare sensory neuropathy resulting from inferior alveolar or mental nerve injury. It manifests as hypoesthesia, paraesthesia, or, rarely, as pain in the chin and lower lip. Several case reports suggest that sickle cell disease (SCD) could be a cause of NCS. However, information about NCS is scarce in this population. Our objectives were to synthesize all the available literature relevant to NCS in SCD and to propose recommendations for diagnosis and management based on the best available evidence. A systematic review was performed on several databases to identify all relevant publications on NCS in adults and children with SCD. We identified 73 publications; fourteen reports met the inclusion/exclusion criteria. These described 33 unique patients. Most episodes of NCS occurred in the context of typical veno-occlusive crises that involved the mandibular area. Radiological signs of bone infarction were found on some imaging, but not all. Neuropathy management was mostly directed toward the underlying cause. Overall, these observations suggest that vaso-occlusion and bone infarction could be important pathophysiological mechanisms of NCS. However, depending on the individual context, we recommend a careful evaluation to rule out differential causes, including infections, local tumors, metastatic disease, and stroke.
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Affiliation(s)
- Mahdi Bedrouni
- Department of Physiology, McGill University, Montréal, QC H3A 0G4, Canada
| | - Lahoud Touma
- Department of Neurosciences, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Caroline Sauvé
- Library, Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 3E4, Canada
| | - Stephan Botez
- Department of Neurosciences, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Denis Soulières
- Departement of Medicine, Division of Hematology and Medical Oncology, Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 3E4, Canada
- Department of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Stéphanie Forté
- Departement of Medicine, Division of Hematology and Medical Oncology, Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 3E4, Canada
- Department of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
- Correspondence:
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Cui Z, Guo Z, Wei L, Zou X, Zhu Z, Liu Y, Wang J, Chen L, Wang D, Ke Z. Altered pain sensitivity in 5×familial Alzheimer disease mice is associated with dendritic spine loss in anterior cingulate cortex pyramidal neurons. Pain 2022; 163:2138-2153. [PMID: 35384934 PMCID: PMC9578529 DOI: 10.1097/j.pain.0000000000002648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Chronic pain is highly prevalent. Individuals with cognitive disorders such as Alzheimer disease are a susceptible population in which pain is frequently difficult to diagnosis. It is still unclear whether the pathological changes in patients with Alzheimer disease will affect pain processing. Here, we leverage animal behavior, neural activity recording, optogenetics, chemogenetics, and Alzheimer disease modeling to examine the contribution of the anterior cingulate cortex (ACC) neurons to pain response. The 5× familial Alzheimer disease mice show alleviated mechanical allodynia which can be regained by the genetic activation of ACC excitatory neurons. Furthermore, the lower peak neuronal excitation, delayed response initiation, as well as the dendritic spine reduction of ACC pyramidal neurons in 5×familial Alzheimer disease mice can be mimicked by Rac1 or actin polymerization inhibitor in wild-type (WT) mice. These findings indicate that abnormal of pain sensitivity in Alzheimer disease modeling mice is closely related to the variation of neuronal activity and dendritic spine loss in ACC pyramidal neurons, suggesting the crucial role of dendritic spine density in pain processing.
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Affiliation(s)
- Zhengyu Cui
- Academy of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Department of Internal Medicine of Traditional Chinese Medicine, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Zhongzhao Guo
- Academy of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Luyao Wei
- Academy of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiang Zou
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Zilu Zhu
- Department of Physiology, School of Basic Medical Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuchen Liu
- Department of Physiology, School of Basic Medical Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jie Wang
- Academy of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Liang Chen
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Deheng Wang
- Department of Physiology, School of Basic Medical Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zunji Ke
- Academy of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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6
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Tsuchimochi A, Endo C, Motoyoshi M, Tamura M, Hitomi S, Hayashi Y, Shinoda M. Effect of low-intensity pulsed ultrasound on orofacial sensory disturbance following inferior alveolar nerve injury: Role of neurotrophin-3 signaling. Eur J Oral Sci 2021; 129:e12810. [PMID: 34236109 DOI: 10.1111/eos.12810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 11/27/2022]
Abstract
Percutaneous treatment of low-intensity pulsed ultrasound (LIPUS) to the site of inferior alveolar nerve (IAN) transection promotes functional regeneration, but the detailed mechanism is unknown. We examined the involvement of neurotrophin-3 (NT-3), which primarily binds with tropomyosin receptor kinase C (TrkC), in functional transected IAN regeneration following LIPUS treatment in rats. Daily LIPUS treatment to the transected IAN was performed, and the mechanical sensitivity of the facial skin was measured for 14 d. On day 5 after IAN transection, the expression of NT-3 in the transected IAN and TrkC-positive trigeminal ganglion neurons were immunohistochemically examined. Further, the effect of TrkC neutralization on the acceleration of facial mechanosensory disturbance restoration due to LIPUS treatment was analyzed. LIPUS treatment to the site of IAN transection significantly facilitated functional recovery from sensory disturbance on facial skin. Schwann cells in the transected IAN expressed NT-3, and LIPUS treatment increased the amount of NT-3. The facilitated recovery from the mechanosensory disturbance by continuous LIPUS treatment was inhibited by the ongoing TrkC neutralization at the IAN transection site. These results suggest that LIPUS treatment accelerates the recovery of orofacial mechanosensory function following IAN transection through the enhancement of NT-3 signaling in the transected IAN.
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Affiliation(s)
- Akane Tsuchimochi
- Department of Orthodontics, Nihon University School of Dentistry, Tokyo, Japan
| | - Chitose Endo
- Department of Orthodontics, Nihon University School of Dentistry, Tokyo, Japan
| | - Mitsuru Motoyoshi
- Department of Orthodontics, Nihon University School of Dentistry, Tokyo, Japan
| | - Miki Tamura
- Department of Physiology, Nihon University School of Dentistry, Tokyo, Japan
| | - Suzuro Hitomi
- Department of Physiology, Nihon University School of Dentistry, Tokyo, Japan
| | - Yoshinori Hayashi
- Department of Physiology, Nihon University School of Dentistry, Tokyo, Japan
| | - Masamichi Shinoda
- Department of Physiology, Nihon University School of Dentistry, Tokyo, Japan
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Guthrie B. Can NSAIDs Be Used Safely for Analgesia in Patients with CKD?: CON. Kidney360 2020; 1:1189-1191. [PMID: 35372868 DOI: 10.34067/kid.0005112020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/22/2020] [Indexed: 12/20/2022]
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8
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Baker ML, Perazella MA. Can NSAIDs Be Used Safely for Analgesia in Patients with CKD?: COMMENTARY. Kidney360 2020; 1:1192-1194. [PMID: 35372870 PMCID: PMC8815502 DOI: 10.34067/kid.0004652020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/10/2020] [Indexed: 06/14/2023]
Affiliation(s)
- Megan L. Baker
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Mark A. Perazella
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
- Veterans Affairs Medical Center, Department of Medicine, West Haven, Connecticut
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9
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Chislett SP, Limjuco AP, Solyar AY, Lanza DC. Cranial nerve V2 and Vidian nerve trauma secondary to lateral pterygoid recess encephalocele repair. Int Forum Allergy Rhinol 2019; 10:81-88. [PMID: 31774620 DOI: 10.1002/alr.22448] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/09/2019] [Accepted: 09/10/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND The incidence of adverse sequelae related to trauma of cranial nerve V2 (V2) and the Vidian nerve (VN) during endoscopic pterygoid recess repair (PRR) of lateral sphenoid encephalocele is insufficiently reported in the medical literature. As part of our quality assessment and improvement program we sought to analyze the incidence and severity of V2 and VN injury during a 9-year experience (2010-2018) with PRR. METHODS Hypoesthesia, paresthesia, and dry eye and their impact on patient quality of life were sought through chart review and a self-reported 0 to 5 Likert scale for each symptom. RESULTS Thirty-five patients underwent repair of spontaneous cerebrospinal-fluid (CSF) rhinorrhea, with 11 consecutive patients undergoing endoscopic PRR. Mean follow-up for PRR was 32.5 months (range, 2.4 to 103.3 months). Although definitive management resulted in 100% success, 1 required secondary treatment. Eight patients were available for long-term follow-up (72.7%) and completed a symptom severity questionnaire using a Likert-scale. All patients observed either hypoesthesia, paresthesia, or dry eye of varying gradation (scale, 0 to 5). None described disabling symptoms, and some reported gradual improvement. Numbness, paresthesia, and dry eye were reported by 6 of 8 (75%), 5 of 8 (62.5%), and 4 of 8 (50%) patients, respectively. The mean Likert score among the 8 patients who completed this questionnaire noticing hypoesthesia, paresthesia, and dry eye was 2.6, 1.3, and 1.8, respectively. CONCLUSION Meticulous surgical technique is paramount for successful PRR and minimizing nerve injury, yet the anatomic variation of the lateral pterygoid recess can be challenging, and neural injury is a real risk. Preoperatively, patients should be counseled that although V2 or VN injury is common, most patients describe resulting symptoms to be rarely bothersome.
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Affiliation(s)
| | - Alexander P Limjuco
- Sinus & Nasal Institute of Florida, St. Petersburg, FL.,Bethlehem ENT Associates, Bethlehem, PA
| | - Alla Y Solyar
- Sinus & Nasal Institute of Florida, St. Petersburg, FL
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Zwart K, Roeling TAP, van Leeuwen WF, Schuurman AH. An Anatomical Study to the Branching Pattern of the Posterior Interosseous Nerve on the Dorsal Side of the Hand. Clin Anat 2019; 33:678-682. [PMID: 31581304 DOI: 10.1002/ca.23486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 08/23/2019] [Accepted: 09/17/2019] [Indexed: 11/08/2022]
Abstract
Partial denervation of the wrist can benefit patients with chronic wrist pain. A complication of partial denervation is loss of proprioception and hypesthesia on the dorsal side of the hand. Our aim is to evaluate whether the sensory branches of the posterior interosseous nerve could contribute to the loss of proprioception and sensation. The branching pattern of the posterior interosseous nerve was studied in 20 cadaveric hands. The terminal branches of the posterior interosseous nerve reached the metacarpophalangeal joints in three specimens (15%), the midshaft of the metacarpals in three specimens (15%), carpometacarpal joints in 11 specimens (55%), and the scapholunate joint in three specimens (15%). The finding that terminal branches of the posterior interosseous nerve can reach the metacarpals and the metacarpophalangeal joints indicates that the posterior nerve may contribute to the proprioception and sensation of the dorsal side of the hand. Clin. Anat., 33:678-682, 2020. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Koen Zwart
- Department of Plastic Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Tom A P Roeling
- Department of Anatomy, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Wouter F van Leeuwen
- Department of Anatomy, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Arnold H Schuurman
- Department of Plastic Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
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Hackenberg RK, von den Driesch A, König DP. Lower Back Pain with Sciatic Disorder Following L5 Dermatome Caused by Herpes Zoster Infection. Orthop Rev (Pavia) 2015; 7:6046. [PMID: 26605030 PMCID: PMC4592933 DOI: 10.4081/or.2015.6046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 09/13/2015] [Indexed: 11/23/2022] Open
Abstract
We report the case of a 62-year-old patient with lower back pain radiating into the right leg accompanied by numbness. The pain had an acute onset and was resistant to conservative pain treatment. A magnetic resonance imaging (MRI) scan of the lumbar spine showed no degenerative discovertebral lesions, but a swelling of the nerve root supplying the affected dermatome. For pain treatment the patient received lumbar epidural infiltrations. During this treatment the patient suddenly developed a skin rash with grouped vesicular blisters on an erythematous ground. After the diagnosis of a lumbar herpes zoster and an acyclovir treatment, the patient could be discharged in an ameliorated condition. This case demonstrates the importance to consider rare causes of lumbosciatic pain and disorders and to acknowledge unspecific changes in a MRI scan.
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Abstract
BACKGROUND Spinal extradural arachnoid cysts are rare expanding lesions in the spinal canal. Enlargement may cause progressive signs and symptoms caused by spinal cord compression. They are associated with trauma, surgery, arachnoiditis, and neural tube defects. Most nontraumatic spinal extradural arachnoid cysts are thought to be congenital. DESIGN Case report and literature review. FINDINGS A 9-year-old boy with mild paraparesis was found to have an extradural multiloculated arachnoid cyst with fibrous septa at T4-L3 levels and anterior compression and displacement of the spinal cord. CONCLUSIONS Definitive treatment of arachnoid cyst entails radical cyst removal and dura cleft repair. Formation of a postoperative cerebrospinal fluid fistula may require external lumbar drainage.
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Affiliation(s)
| | | | | | - Sait Sirin
- Department of Neurosurgery, GATA, Ankara, Turkey
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