No abstract available.
Chordoma* ; Diagnosis* ; Neuralgia*

Zoster sine herpete (ZSH) is difficult to diagnosis during an acute period due to the absence of the characteristic zosteriform dermatomal rash; therefore, progression to postherpetic neuralgia is more common than typical zoster. In addition, misdiagnosis of other neuropathic pain as ZSH is common in clinical situations. Here, we report a case of spinal arteriovenous malformation that mimics ZSH. This is a rare condition; therefore, high clinical suspicion for a correct diagnosis and proper examination are not easy. However, early diagnosis and definitive treatment are essential to prevent neurologic deficit and mortality.
Arteriovenous Malformations ; Diagnostic Errors ; Early Diagnosis ; Herpes Zoster ; Neuralgia ; Neuralgia, Postherpetic ; Neurologic Manifestations ; Zoster Sine Herpete

A case of epidermoid cyst in the cerebello-pontine angle, resulting in trigeminal neuralgia, is presented. There were no abnormal findings in the clinical and radiologic examination except the typical neuralgic pain. The tumor was found incidentally during posterior fossa exploration for neurovascular decom pression of the trigeminal nerve under diagnosis of primary trigeminal neuralgia. The patient was treated with only removal of the tumor.
Diagnosis ; Epidermal Cyst* ; Humans ; Trigeminal Nerve ; Trigeminal Neuralgia*

PURPOSE: To evaluate the radiologic findings of carotid-vertebrobasilar anastomosis and associated anomalies. MATERIALS AND METHODS: Thirteen patients with fourteen cases of carotid-vertebrobasilar anastomosis collectedfrom January 1992 to December 1997 were reviewed. Clinical diagnosis refered for cerebral angiography werecerebral infarction(n=3), intracranial hemorrhage(n=2), subarachnoid hemorrhage(n=1), brain tumor(n=3),arteriovenous malformation(n=3) and trigeminal neuralgia(n=1). Cerebral angiograms and clinical symptoms wereretrospectively analyzed. RESULTS: The fourteen carotid-vertebrobasilar anastomsis consisted of eleven cases ofpersistent trigeminal artery and three cases of type I proatantal intersegmental artery. Persistent trigeminalarteries were associated with anterior communicating artery aneurysm(n=1), posterior fossa arteriovenousmalformation(n=2) and persistent trigeminal artery variant(n=5). Type I proatantal intersegmental arteries wereassociated with hypoplastic vertebral arteries(n=2) : only proximal segment in one, and proximal and distalsegments in one case. Only one patient had clinical symptom related to the carotid-vertebrobasilar anastomosiswhich was trigeminal neuralgia. CONCLUSION: Knowledge of the anatomical and radiologic findings ofcarotid-vertebrobasilar anastomosis and associated anomalies will aid in the accurate diagnosis of neurovasculardisease and prevent possible complications during surgical and interventional procedures.
Arteries ; Brain ; Cerebral Angiography ; Diagnosis ; Humans ; Trigeminal Neuralgia

Pudendal neuralgia is characterized by severe sharp pain along the innervation area of pudendal nerve, which may be worsened when sitting position. Successful pudendal nerve block is crucial to the diagnosis of pudendal neuralgia. Although fluoroscopy-guided pudendal nerve blocks have traditionally been performed, recently ultrasound-guided pudendal nerve blocks were reported. For the long term effect of nerve block, pulsed radiofrequency was performed under fluoroscopic guidance in some reports. We report our successful experiences of three cases using ultrasound-guided pulsed radiofrequency.
Diagnosis ; Humans ; Nerve Block ; Pudendal Nerve* ; Pudendal Neuralgia*

PURPOSE: Pudendal neuralgia (PN) is a painful and disabling condition, which reduces the quality of life as well. Pudendal nerve infiltrations are essential for the diagnosis and the management of PN. The purpose of this study was to compare the effectiveness of finger-guided transvaginal pudendal nerve infiltration (TV-PNI) technique and the ultrasound-guided transgluteal pudendal nerve infiltration (TG-PNI) technique.METHODS: Forty patients who underwent PNI for the diagnosis of PN were evaluated. Thirty-five of these 40 patients, who were diagnosed as PN, underwent a total of 70 further unilateral PNI. All the patients underwent PNI for twice after the first diagnostic PNI, 1 week apart.RESULTS: In the ultrasound (US)-guided TG-PNI group, the success rate was 68.8% (11 of 16) in both “pain in the sitting position” and “pain in the region from the anus to the clitoris.” The success rate of blocks in the US-guided TG-PNI group was 75% (12 of 16) in terms of pain during/after intercourse. In the finger-guided TV-PNI group, the success rate was 84.2% in both “pain in the sitting position” and “pain in the region from the anus to the clitoris.” The success rate of blocks in the fingerguided TV-PNI group was 89.5% (17 of 19) in terms of pain during/after intercourse. There was no statistically significant difference in the success rate of the 3 assessed conditions between the 2 groups (P>0.05).CONCLUSIONS: The TV-PNI may be an alternative to US-guidance technique as a safe, simple, effective approach in pudendal nerve blocks.
Anal Canal ; Anesthesia, Obstetrical ; Diagnosis ; Humans ; Nerve Block ; Neuralgia ; Pelvic Pain ; Pudendal Nerve ; Pudendal Neuralgia ; Quality of Life ; Ultrasonography ; Ultrasonography, Interventional

Being located in the hypogastric area, the ilioinguinal nerve, together with iliohypogastric nerve, can be damaged during lower abdominal surgeries. Conventionally, the diagnosis of ilioinguinal neuropathy relies on clinical assessments, and standardized diagnostic methods have not been established as of yet. We hereby report the case of young man who presented ilioinguinal neuralgia with symptoms of burning pain in the right groin and scrotum shortly after receiving inguinal herniorrhaphy. To raise the diagnostic certainty, we used a real-time ultrasonography (US) to guide a monopolar electromyography needle to the ilioinguinal nerve, and then performed a motor conduction study. A subsequent US-guided ilioinguinal nerve block resulted in complete resolution of the patient's neuralgic symptoms.
Burns ; Diagnosis* ; Electromyography* ; Groin ; Herniorrhaphy ; Needles ; Nerve Block ; Neuralgia ; Scrotum ; Ultrasonography*

Neuropathic pain after spinal surgery, the so-called failed back surgery syndrome (FBSS), is a frequently observed troublesome disease entity. Although medications may be effective to some degree, many patients continue experiencing intolerable pain and functional disability. Only gabapentin has been proven effective in patients with FBSS. No relevant studies regarding manipulation or physiotherapy for FBSS have been published. Spinal cord stimulation (SCS) has been widely investigated as a treatment option for chronic neuropathic pain, including FBSS. SCS was generally accepted to improve chronic back and leg pain, physical function, and sleep quality. Although the cost effectiveness of SCS has been proved in many studies, its routine application is limited considering that it is invasive and is associated with safety issues. Percutaneous epidural adhesiolysis has also shown good clinical outcomes; however, its effects persisted for only a short period. Because none of the current methods provide absolute superiority in terms of clinical outcomes, a multidisciplinary approach is required to manage this complex disease. Further studies concerning the etiology, diagnosis, treatment, and cost effectiveness of FBSS are warranted to deepen our understanding of this condition.
Cost-Benefit Analysis ; Diagnosis ; Failed Back Surgery Syndrome ; Humans ; Leg ; Neuralgia* ; Spinal Cord Stimulation

Thoracic paravertebral block is performed for the treatment of patients with chronic pain, such as complex regional pain syndrome (CRPS) and post-herpetic neuralgia. Thoracic paravertebral block can result in iatrogenic pneumothorax. Because pneumothorax can develop into medical emergencies and needle aspiration or chest tube placement may be needed, early diagnosis is very important. Recently, thoracic ultrasonography has begun to be used to diagnose pneumothorax. In addition, ultrasound-guided aspiration can be an accurate and safe technique for treatment of pneumothorax, as the needle position can be followed in real time. We report a case of iatrogenic pneumothorax following thoracic paravertebral block for the treatment of chronic pain due to CRPS, treated successfully by ultrasound-guided aspiration.
Chest Tubes ; Chronic Pain ; Early Diagnosis ; Emergencies ; Humans ; Needles ; Neuralgia ; Pneumothorax

Peripheral neuropathies are common in neurological practice, but it is also tue that they are common in many other medical and surgical fields. There are hundreds and thousands causes of peripheral neuropathies, and a variety of clinical manifestations. Diagnostic approach includes through history taking, neurologic examination focused on the motor and sensory system, serologic investigation with proper electrodiagnostic studies. The first and essential step is to know the clinical characteristics of peripheral neuropathies and caterogorize them to subtype for differential diagnosis. However, up to 30% of the neuropathy remains idiopathic despite of extensive evaluation. Symptomatic management with serial follow up is essential in these cryptogenic neuropathies. Herein, the clinical symptoms and signs of peripheral neuropathy and symptomatic management of neuropathic pain will be briefly reviewed.
Diagnosis, Differential ; Follow-Up Studies ; Neuralgia ; Neurologic Examination ; Peripheral Nervous System Diseases* ; Polyneuropathies