RESUMO
Introducción: El neumoencéfalo (sinonimia: aerocele o neumatocele intracerebral), se define como la presencia de gas dentro de cualquiera de los compartimentos intracraneales (intraventricular, intraparenquimatosa, subaracnoidea, subdural y epidural). Objetivo: Describir los hallazgos clínicos, estudios complementarios, conducta terapéutica y evolución de un caso con neumoencéfalo como complicación de bloqueo regional epidural por radiculopatía lumbosacra. Presentación de caso: Se presentó un paciente masculino de 57 años de edad que comenzó con un cuadro súbito de desorientación, excitabilidad psicomotriz y convulsiones tónico-clónicas, a partir de una inyección epidural de metilprednisolona como método analgésico. Conclusiones: El caso presentado exhibió manifestaciones neurológicas inespecíficas, la aparición súbita posterior al proceder invasivo hizo sospechar en un evento neurológico agudo o fenómeno tromboembólico. Los estudios complementarios como la tomografía axial computarizada craneal simple, permitió su diagnóstico para tener una conducta consecuente. El manejo conservador del neumoencéfalo como complicación del uso de anestesia epidural, constituyó una conducta terapéutica eficaz y repercutió en la satisfactoria evolución del paciente(AU)
Introduction: Pneumocephalus (synonym: aerocele or intracerebral pneumatocele), is defined as the presence of gas within any of the intracranial compartments (intraventricular, intraparenchymal, subarachnoid, subdural and epidural). Objective: To describe the clinical findings, complementary studies, therapeutic conduct and evolution of a case with pneumocephalus as a complication of regional epidural block due to lumbosacral radiculopathy Case presentation: A 57-year-old male patient was presented who began with a sudden episode of disorientation, psychomotor excitability and tonic-clonic seizures, following an epidural injection of methylprednisolone as an analgesic method. Conclusions: The case presented exhibited non-specific neurological manifestations, the sudden appearance after the invasive procedure raised suspicion of an acute neurological event or thromboembolic phenomenon. Complementary studies such as simple cranial computed axial tomography, allowed its diagnosis to have a consistent conduct. The conservative management of pneumocephalus as a complication of the use of epidural anesthesia constituted an effective therapeutic approach and had an impact on the patient's satisfactory evolution(AU)
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Radiculopatia/complicações , Metilprednisolona/uso terapêutico , Pneumoencefalografia/métodos , Tomografia Computadorizada Espiral/métodos , Anestesia Epidural/métodosRESUMO
OBJECTIVE: Sleep disturbance in chronic neuropathic low back pain is a well-known condition. In this study, we aimed to investigate the effect of lumbar radiculopathy on sleep quality and lower extremity functionality in the presence of neuropathic low back pain. METHODS: A total of 79 patients diagnosed with disk herniation, needle electromyography, and neuropathic pain were included in the study. Visual Analog Scale, Pittsburg Sleep Quality Index, and Lower Extremity Functionality Scale were applied to the patients. RESULTS: Of the 79 patients who participated in the study, 34 (43%) were females and 45 (57%) were males. No significant difference was found between the group with and without radiculopathy in terms of sleep quality and lower extremity functionality (p=0.245 and p=0.092, respectively). In our study, a negative correlation was found between night pain and the presence of radiculopathy (p=0.006). The number of lumbar herniated disk levels was higher in the group without radiculopathy and was statistically significant (p=0.023). CONCLUSION: We found that the presence of radiculopathy did not affect sleep quality and lower extremity functionality in disk herniation patients with neuropathic pain. Although it was not statistically significant in our study, we think that the degree of herniation may affect sleep and lower extremity functionality rather than the number of disk herniation levels with the available data. The fact that neuropathic pain is not limited to disk herniation and radiculopathy, and that neuropathic pain is intertwined with clinical conditions such as anxiety, sleep disorders, and depression are among the conditions that make the studies difficult.
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Deslocamento do Disco Intervertebral , Dor Lombar , Neuralgia , Radiculopatia , Transtornos do Sono-Vigília , Feminino , Masculino , Humanos , Radiculopatia/complicações , Qualidade do Sono , Deslocamento do Disco Intervertebral/complicações , Neuralgia/etiologia , Extremidade Inferior , Transtornos do Sono-Vigília/complicaçõesRESUMO
INTRODUCTION: Expansive intra-spinal processes usually have an insidious course that makes their early diagnosis difficult. Intra-spinal tumors are classified according to their location in the spinal canal: extradural and intradural, and these are classified as extramedullary and intramedullary. At the beginning, they can cause non-specific pain conditions and, sometimes, root-type pain. The patient may have symptoms such as: loss of strength, loss of balance, loss of sensation, sphincter disorders. Intra-spinal neoplasms, when diagnosed, have an indication for surgical treatment. MATERIAL AND METHODS: The clinical case of a 14-year-old male adolescent is described, pain in the lumbar region for four years, of insidious onset, intermittent, progressive, exacerbated six months ago, with radiation to the lower extremities, which is accompanied by progressive paresthesia and paresis predominantly in the lower right limb. RESULTS: Bilateral L4 and L5 laminotomy is performed, exploration and resection of the tumor and release of nerve roots. Tumor with characteristics similar to adipose tissue is obtained, where a wide vascular network is observed inside, with an approximate size of 14 × 10 × 4 mm, ovoid in shape, flattened with a smooth and shiny surface. CONCLUSION: Spinal tumors are relatively rare tumors, however, of these tumors, the extradural intraspinal location accounts for half of the cases. In our patient, the diagnosis of lipoma of the filum terminale was integrated, which corresponds to less than 1% of all tumors of the spine.
INTRODUCCIÓN: Los procesos expansivos intrarraquídeos suelen tener una evolución insidiosa que dificultan su diagnóstico precoz. Los tumores intrarraquídeos son clasificados de acuerdo con su localización en el conducto raquídeo: extradural e intradural, y éstos se clasifican en extramedular e intramedular. Al comienzo, pueden provocar cuadros de dolor poco específicos y, a veces, dolores de tipo radicular. El paciente podrá tener síntomas como: pérdida de fuerza, pérdida de equilibrio, pérdida de sensibilidad y disturbios esfinterianos. Las neoplasias intrarraquídeas, cuando son diagnosticadas, tienen indicación de tratamiento quirúrgico. MATERIAL Y MÉTODOS: Se describe el caso clínico de adolescente masculino de 14 años, dolor en región lumbar desde hace cuatro años, de inicio insidioso, intermitente, progresivo, que se exacerba hace seis meses, con irradiación a extremidades inferiores, que se acompaña de parestesias y paresias progresivas de predominio en extremidad inferior derecha. RESULTADOS: Se realiza laminotomía L4 y L5 bilateral, exploración y resección de tumoración y liberación de raíces nerviosas. Se obtiene tumor de características similares a tejido adiposo en donde se observa amplia red vascular en su interior, con tamaño aproximado de 14 × 10 × 4 mm de forma ovoide, aplanada con superficie lisa y brillante. CONCLUSIÓN: Los tumores raquimedulares son tumores relativamente raros; sin embargo, de estos tumores, la localización intrarraquídea extradural corresponde a la mitad de los casos. En nuestro paciente, se integró el diagnóstico de lipoma del filum terminale, el cual corresponde a menos de 1% de todos los tumores de la columna vertebral.
Assuntos
Radiculopatia , Neoplasias da Coluna Vertebral , Adolescente , Detecção Precoce de Câncer/efeitos adversos , Humanos , Laminectomia/efeitos adversos , Masculino , Dor , Radiculopatia/complicações , Radiculopatia/cirurgia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/cirurgiaRESUMO
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The goal of the present study was to determine whether neck pain responds differently to anterior cervical discectomy and fusion (ACDF) between patients with cervical radiculopathy and/or cervical myelopathy. SUMMARY OF BACKGROUND DATA: Many patients who undergo ACDF because of radiculopathy/myelopathy also complain of neck pain. However, no studies have compared the response of significant neck pain to ACDF. METHODS: Patients undergoing one to three-level primary ACDF for radiculopathy and/or myelopathy with significant (Visual Analogue Scale [VAS] ≥ 3) neck pain and a minimum of 1-year follow-up were included. Based on preoperative symptoms patients were split into groups for analysis: radiculopathy (R group), myelopathy (M group), or both (MR group). Groups were compared for differences in Health Related Quality of Life outcomes: Physical Component Score-12, Mental Component Score (MCS)-12, Neck Disability Index, VAS neck, and VAS arm pain. RESULTS: Two hundred thirty-five patients met inclusion criteria. There were 117 patients in the R group, 53 in the M group, and 65 in the MR group. Preoperative VAS neck pain was found to be significantly higher in the R group versus M group (6.5 vs. 5.5; Pâ=â0.046). Postoperatively, all cohorts experienced significant (Pâ<â0.001) reduction in VAS neck pain, (ΔVAS neck; R group: -2.9, M: -2.5, MR: -2.5) with no significant differences between groups. However, myelopathic patients showed greater improvement in absolute MCS-12 scores (Pâ=â0.011), RR (Pâ=â0.006), and % minimum clinically important difference (Pâ=â0.013) when compared with radiculopathy patients. This greater improvement remained following regression analysis (Pâ=â0.025). CONCLUSION: Patients with substantial preoperative neck pain experienced significant reduction in their neck pain, disability, and physical function following ACDF, whether treated for radiculopathy or myelopathy. However, in this study, only myelopathy patients had significant improvements in their mental function as represented by MCS improvements. LEVEL OF EVIDENCE: 3.
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Vértebras Cervicais/cirurgia , Discotomia/tendências , Cervicalgia/cirurgia , Radiculopatia/cirurgia , Doenças da Medula Espinal/cirurgia , Fusão Vertebral/tendências , Adulto , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Cervicalgia/diagnóstico , Cervicalgia/etiologia , Medição da Dor/métodos , Medição da Dor/tendências , Radiculopatia/complicações , Radiculopatia/diagnóstico , Estudos Retrospectivos , Doenças da Medula Espinal/complicações , Doenças da Medula Espinal/diagnóstico , Resultado do TratamentoRESUMO
PURPOSE: To report the distribution of the different patterns of stretch brachial plexus injuries (BPIs) in a retrospective cohort of patients operated at our institution during an 11-year period. METHODS: From September 2002 to June 2012, we evaluated and operated on 565 patients with traction injuries of the brachial plexus. Average age was 26.8 years (SD ±9.3 years); the interval between the injury and surgery was 5.4 months (SD ±2.8 months). The pattern of injury was defined based on data obtained from a standardized clinical examination, preoperative helical computed tomography myelography after intradural contrast injection, surgical findings, and intraoperative electric stimulation. RESULTS: Supraclavicular injuries accounted for 91% of all cases (N = 512) whereas 9% of injuries were infraclavicular. Within the supraclavicular injuries, 50% of cases involved the entire plexus and in 12% there was avulsion of all 5 roots. Among them, 94% involved the upper plexus (C5 to C6 ± C7 ± C8), and 6% the lower plexus (C8 to T1 ± C7). C5 to C6 injuries accounted for 23% of partial BPI, C5 to C7 19%, C5 to C8 52%, C7 to T1 4%, and C8 to T1 2%. CONCLUSIONS: The most relevant findings of this study were that most panplexal BPIs showed at least one graftable root, there was a high prevalence of C5 to C8 BPI, C7 to T1 root injury was the most common pattern of lower type of injury, and infraclavicular BPI was uncommon. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic IV.
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Neuropatias do Plexo Braquial/etiologia , Neuropatias do Plexo Braquial/cirurgia , Plexo Braquial/lesões , Paralisia/etiologia , Paralisia/cirurgia , Adulto , Neuropatias do Plexo Braquial/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paralisia/diagnóstico , Estudos Prospectivos , Radiculopatia/complicações , Radiculopatia/diagnóstico , Radiculopatia/cirurgia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
No study has directly compared the effectiveness of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct-current stimulation (tDCS) in neuropathic pain (NP). In this 2-centre randomised double-blind sham-controlled study, we compared the efficacy of 10-Hz rTMS and anodal 2-mA tDCS of the motor cortex and sham stimulation contralateral to the painful area (3 daily sessions) in patients with NP due to lumbosacral radiculopathy. Average pain intensity (primary outcome) was evaluated after each session and 5 days later. Secondary outcomes included neuropathic symptoms and thermal pain thresholds for the upper limbs. We used an innovative design that minimised bias by randomly assigning patients to 1 of 2 groups: active rTMS and tDCS or sham rTMS and tDCS. For each treatment group (active or sham), the order of the sessions was again randomised according to a crossover design. In total, 51 patients were screened and 35 (51% women) were randomized. Active rTMS was superior to tDCS and sham in pain intensity (F = 2.89 and P = 0.023). Transcranial direct-current stimulation was not superior to sham, but its analgesic effects were correlated to that of rTMS (P = 0.046), suggesting common mechanisms of action. Repetitive transcranial magnetic stimulation lowered cold pain thresholds (P = 0.04) and its effect on cold pain was correlated with its analgesic efficacy (P = 0.006). However, rTMS had no impact on individual neuropathic symptoms. Thus, rTMS is more effective than tDCS and sham in patients with NP due to lumbosacral radiculopathy and may modulate the sensory and affective dimensions of pain.
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Córtex Motor/fisiopatologia , Neuralgia/terapia , Radiculopatia/complicações , Estimulação Transcraniana por Corrente Contínua/métodos , Estimulação Magnética Transcraniana/métodos , Adulto , Idoso , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia/etiologia , Neuralgia/fisiopatologia , Manejo da Dor/métodos , Radiculopatia/fisiopatologia , Resultado do TratamentoRESUMO
Chikungunya virus (CHIKV) is a mosquito-borne alphavirus that is endemic to parts of Africa, South and Southeast Asia, and more recently the Caribbean. Patients typically present with fever, rash, and arthralgias, though neurologic symptoms, primarily encephalitis, have been described. We report the case of a 47-year-old woman who was clinically diagnosed with CHIKV while traveling in the Dominican Republic and presented 10 days later with left lower extremity weakness, a corresponding enhancing thoracic spinal cord lesion, and positive CHIKV serologies. She initially responded to corticosteroids, followed by relapsing symptoms and gradual clinical improvement. The time lapse between acute CHIKV infection and the onset of myelopathic sequelae suggests an immune-mediated phenomenon rather than direct activity of the virus itself. Chikungunya virus should be considered in the differential diagnosis of myelopathy in endemic areas. The progression of symptoms despite corticosteroid administration suggests more aggressive immunomodulatory therapies may be warranted at disease onset.
Assuntos
Febre de Chikungunya/diagnóstico , Neuralgia/diagnóstico , Radiculopatia/diagnóstico , Doenças da Medula Espinal/diagnóstico , Corticosteroides/uso terapêutico , Febre de Chikungunya/complicações , Febre de Chikungunya/tratamento farmacológico , Febre de Chikungunya/fisiopatologia , Vírus Chikungunya/patogenicidade , Vírus Chikungunya/fisiologia , República Dominicana , Feminino , Humanos , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Neuralgia/complicações , Neuralgia/tratamento farmacológico , Neuralgia/fisiopatologia , Radiculopatia/complicações , Radiculopatia/tratamento farmacológico , Radiculopatia/fisiopatologia , Medula Espinal/efeitos dos fármacos , Medula Espinal/fisiopatologia , Medula Espinal/virologia , Doenças da Medula Espinal/complicações , Doenças da Medula Espinal/tratamento farmacológico , Doenças da Medula Espinal/fisiopatologia , Viagem , Estados UnidosRESUMO
Introducción: La evaluación clínica de dolor radicular asocia síntomas y signos del fenotipo doloroso con el mecanismo de base. La escala de evaluación estandarizada del dolor (StEP) diferencia dolor lumbar axial del radicular mediante interrogatorio (3 preguntas) y examen físico (8 pruebas). Objetivo: Adaptar la escala StEP al español. Metodología: Selección de escala, traducción-retraducción, ajustes ítems y utilidad, prueba piloto, análisis de validez y confiabilidad. Inclusión: Cualquier género, mayor de 18 años, dolor lumbar con o sin irradiación, que firmen consentimiento informado. Exclusión: Neuropatías, polineuropatías, miopatías, enfermedad neurológica, miofascial, venosa, siquiátrica, cardiovascular, postoperados. Muestra: 21 pacientes. Resultados: Evaluación en 2 ocasiones por paciente, intervalo de una semana, 2 evaluadores. 21 pacientes, 9 femeninos (42.9%) y 12 masculinos (57.1%); edad: 22 a 58 años (media 38). Diagnósticos: lumbalgia 7 (33.3%), lumbociática 6 (28.6%), hernia discal 5 (23.8%), espondilolistesis 2 (9.5%), radiculopatía 1 (4.8%). Evaluador 1: axial 18 (85.7%), radicular 3 (14.3%). Evaluador 2: axial 14 (66.7%), radicular 7 (33.3%). Resultados de validez adecuados. Consistencia interna (alpha de Cronbach) 0.7. Tiempo prueba/reprueba: 15 a 10 minutos. Confiabilidad inter-evaluador (índice Kappa) 0.5. Conclusión: La escala presenta variabilidad en la identificación del dolor radicular en comparación a lo reportado inicialmente por su autor; sin embargo, se considera de utilidad en la identificación clínica de la radiculopatía.
Introduction: The clinical assessment of radicular pain associates the signs and symptoms of the painful phenotype with the underlying mechanism. The Standardized Evaluation of Pain (StEP) distinguishes between axial and radicular lumbar pain by means of a questionnaire (3 questions) and a physical exam (8 tests). Objective: To adapt the StEP scale to Spanish. Methodology: Selection of the scale, translation-back translation, adjustments, items and utility, pilot test, validity and reliability tests. Inclusion criteria: Any sex, over age 18, lumbar pain with or without irradiation, signing of the informed consent. Exclusion criteria: Neuropathies, polyneuropathies, myopathies, neurologic, myofascial, venous, psychiatric, cardiovascular disease, postoperative status. Sample: 21 patients. Results: Patients were assessed twice with a one-week interval with the help of 2 evaluators. There were 21 patients, 9 females (42.9%) and 12 males (57.1%); ages 22-58 years (mean 38). Diagnoses: low back pain, 7 (33.3%); lumbosciatica, 6 (28.6%); disc herniation, 5 (23.8%); spondylolisthesis, 2 (9.5%); radiculopathy, 1 (4.8%). Evaluator 1: axial, 18 (85.7%); radicular, 3 (14.3%). Evaluator 2: axial, 14 (66.7%); radicular, 7 (33.3%). Validity results were appropriate. Internal consistency (Cornbach's alpha), 0.7. Test/re-test time: 10-15 minutes. Inter-evaluator reliability (Kappa index), 0.5. Conclusion: The scale showed variability in identifying radicular pain compared to what its author reported initially. However, it is considered as a useful tool to clinically identify radiculopathy.
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Dor Lombar/etiologia , Medição da Dor/normas , Radiculopatia/complicações , Idioma , México , Reprodutibilidade dos Testes , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: The clinical assessment of radicular pain associates the signs and symptoms of the painful phenotype with the underlying mechanism. The Standardized Evaluation of Pain (StEP) distinguishes between axial and radicular lumbar pain by means of a questionnaire (3 questions) and a physical exam (8 tests). OBJECTIVE: To adapt the StEP scale to Spanish. METHODOLOGY: Selection of the scale, translation-back translation, adjustments, items and utility, pilot test, validity and reliability tests. Inclusion criteria: Any sex, over age 18, lumbar pain with or without irradiation, signing of the informed consent. Exclusion criteria: Neuropathies, polyneuropathies, myopathies, neurologic, myofascial, venous, psychiatric, cardiovascular disease, postoperative status. Sample: 21 patients. RESULTS: Patients were assessed twice with a one-week interval with the help of 2 evaluators. There were 21 patients, 9 females (42.9%) and 12 males (57.1%); ages 22-58 years (mean 38). Diagnoses: low back pain, 7 (33.3%); lumbosciatica, 6 (28.6%); disc herniation, 5 (23.8%); spondylolisthesis, 2 (9.5%); radiculopathy, 1 (4.8%). Evaluator 1: axial, 18 (85.7%); radicular, 3 (14.3%). Evaluator 2: axial, 14 (66.7%); radicular, 7 (33.3%). Validity results were appropriate. Internal consistency (Cornbach's alpha), 0.7. Test/ re-test time: 10-15 minutes. Inter-evaluator reliability (Kappa index), 0.5. CONCLUSION: The scale showed variability in identifying radicular pain compared to what its author reported initially. However, it is considered as a useful tool to clinically identify radiculopathy.
Assuntos
Dor Lombar/etiologia , Medição da Dor/normas , Radiculopatia/complicações , Adulto , Feminino , Humanos , Idioma , Masculino , México , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Inquéritos e Questionários , Adulto JovemRESUMO
While CMV myeloradiculitis is a known complication in AIDS patients with severe immunosuppression, HSV-2 necrotizing myeloradiculitis is rare and often associated with disabling a fatal outcome. We hereby describe a 46 year-old HIV infected patient with profound and sustained immunosuppression who presented with an acute ascending paraparesis and urinary retention. Lumbar spine MRI showed contrast enhancement at the conus medullaris and cauda equine, and both CMV and HSV-2 CSF PCR were positive. Despite treatment, the patient died 20 days later. We review the main diagnostic and therapeutic aspects of herpes virus associated myeloradiculitis and discuss the approach in similar cases.