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A Case Report of Giant Cell Arteritis Combined with Oculomotor Nerve Palsy.

Young Bin RYU ; Kyung Ream HAN ; Chan KIM

The Korean Journal of Pain.2007;20(2):255-257. doi:10.3344/kjp.2007.20.2.255

Giant cell arteritis, which is also referred to as temporal arteritis, is defined as a systemic vasculitis in individuals over 50 years of age. Here, we report a case of giant cell arteritis combined with oculomotor nerve palsy. An 81-year old female patient experienced a headache for 10 days in her left temporoparietal area, that was characterized by a continuous dull ache and heaviness with intermittent shooting and lancinating pain. Her symptoms persisted in spite of receiving strong analgesics in another hospital. Upon physical examination, she was found to have marked tenderness over the left temporal area, especially along the path of the temporal artery as well as limitation of adduction, supraduction and infraduction of the left eyeball. At the time of admission, her erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were 52 mm/hr and 3.94 mg/dl. In addition her brain MRI revealed no specific findings. Giant cell arteritis was suspected based on the clinical symptoms and signs as well as the elevated ESR and CRP. Oral steroid therapy started was started with an initial dose of 40 mg of prednisolone per day that was gradually tapered to 5 mg a day for 2 weeks. Her headache subsided one day after the steroid therapy and oculomotor nerve palsy was markedly improved after 2 weeks of the therapy. After 2 months she had recovered completely from her symptoms.
Aged, 80 and over ; Analgesics ; Blood Sedimentation ; Brain ; C-Reactive Protein ; Female ; Giant Cell Arteritis* ; Giant Cells* ; Headache ; Humans ; Magnetic Resonance Imaging ; Oculomotor Nerve Diseases* ; Oculomotor Nerve* ; Physical Examination ; Prednisolone ; Systemic Vasculitis ; Temporal Arteries

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Perineal Pain due to Bladder Stones after Total Abdominal Hysterectomy: A case report.

Sang Hyun PARK ; Jong Cook PARK ; Pyung Bok LEE

The Korean Journal of Pain.2007;20(2):251-254. doi:10.3344/kjp.2007.20.2.251

Perineal pain is a significant diagnostic challenge to the pain practitioner, and accurate diagnosis and treatment is essential. We report a case of 42-years old female patient suffering from excruciating vulvodynia for 5 years. Her pain on the visual analogue scale was 10 out of 10 and her pain was associated with sleep disturbance, dyspareunia, and chronic fatigue. She was diagnosed with a bladder stone by imaging, and The pain was relieved by cystolitholapaxy.
Adult ; Diagnosis ; Dyspareunia ; Fatigue ; Female ; Humans ; Hysterectomy* ; Urinary Bladder Calculi* ; Urinary Bladder* ; Vulvodynia

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Positive Effects of Local Anesthetic Nerve Blocks for a Patient with Newly Developed Left Side Spasmodic Torticollis after Surgical Intervention of Right Side Spasmodic Torticollis: A case report.

Chang Hoon CHOI ; Jin Hwan CHOI ; Choon Ho SUNG

The Korean Journal of Pain.2007;20(2):246-250. doi:10.3344/kjp.2007.20.2.246

We report here on a case of right side spasmodic torticollis (ST) that was refractory to botulinum toxin type A injection and medication.The patient finally underwent a selective ramisectomy with ipsilateral sternocleidomastoid muscle (SCM) resection, but the remaining symptoms slowly aggravated, and a contralateral left side SCM spasm began.As conservative therapy for reducing the spasmodic symptoms, accessory nerve block, upper cervical plexus block and stellate ganglion block were performed twice in a week.After 6 months, the spasmodic symptoms significantly decreased. The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) decreased by more than 70%.After one year of serial intermittent local anesthetic blockade therapy, the patient became almost free from the original ST symptoms (TWSTRS = 1).Serial local anesthetic interventions for the ST patient may have a beneficial role on the pathological peripherocentral neural activity of the ST patient and can modulate motor-sensory integration in the patient.
Accessory Nerve ; Botulinum Toxins, Type A ; Cervical Plexus ; Humans ; Nerve Block* ; Spasm ; Stellate Ganglion ; Torticollis*

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Intrathecal Catheter and Subcutaneous Access Port Implantation in Pain Management for Terminal Cancer Patient: A case report.

Kwi Chu SEO ; Jin Yong CHUNG ; Ho Young KIM ; Woon Seok RHO ; Bong Il KIM ; Seok Young SONG

The Korean Journal of Pain.2007;20(2):240-245. doi:10.3344/kjp.2007.20.2.240

It is important to treat cancer-related pain in cancer patients to ensure the life quality of the patient, as well as to improve their life span. It has been estimated that at least 5% of cancer patients have pain refractory to medical treatment. Therefore, the need for epidural or intrathecal analgesia with opioids and local anesthetics is indicated if systemic treatment has failed. Intrathecal catheter placement and implantation of the injection port for administration of opioids and local anesthetics may improve pain relief in patients who are unresponsive to epidural routes. Although intrathecal implantation has several complications, similar infection rates have been reported between intrathecal and epidural administration. In addition, intrathecal administration showed better outcomes, including improved pain control, lowered daily doses, and an improvement in the level of drowsiness experienced when compared to epidural administration. We report here a case in which a terminal cancer patient was treated using an intrathecal catheter and subcutaneous port. The patient had cancer-related pain that could not be controlled by epidural opioid administration. Based on the results presented here, we suggest that intrathecal implantation is a feasible long term pain management method for intractable cancer pain patients.
Analgesia ; Analgesics, Opioid ; Anesthetics, Local ; Catheters* ; Humans ; Pain Management* ; Quality of Life ; Sleep Stages

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A Case of Subdural Hematoma after Epidural Blood Patch in a Spontaneous Intracranial Hypotensive Patient: A case report.

Yeui Seok KIM ; Kyung Ream HAN ; Chan KIM

The Korean Journal of Pain.2007;20(2):235-239. doi:10.3344/kjp.2007.20.2.235

Spontaneous intracranial hypotension (SIH) is believed to be a benign disease. However, numerous studies have reported serious complications related to SIH, including subdural hematoma. In this case report, a 54- year-old male patient visited the emergency room with orthostatic headache. A brain magnetic resonance imaging (MRI) study showed diffuse mild thickening and enhancement of pachymeninges, with a suspicious minimal amount of subdural fluid collected in the left posterior parietal area. His orthostatic headache showed no improvement with conservative treatment; but his pain was almost completely relieved after two trials of cervical epidural blood patch. On the 74th day after the onset of his pain, the patient showed a drowsy mental status and slurred speech when he visited the pain clinic. Brain computerized tomography indicated a left subdural hemorrhage, and he underwent emergency operation to drain the SDH. In conclusion, pain clinicians should pay attention to abrupt changes in mental status as well as continuous headache, for the early diagnosis of SDH in SIH patients.
Blood Patch, Epidural* ; Brain ; Early Diagnosis ; Emergencies ; Emergency Service, Hospital ; Headache ; Hematoma, Subdural* ; Humans ; Intracranial Hypotension ; Magnetic Resonance Imaging ; Male ; Pain Clinics ; Rabeprazole

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Pulsed Radiofrequency Lesioning of the Suprascapular Nerve for Referred Shoulder Pain due to Metastatic Liver Cancer: A case report.

Hyung Tae KIM ; In Su JANG ; Sang Ji HAN ; Jun Hak LEE ; Young Eun KWON

The Korean Journal of Pain.2007;20(2):230-234. doi:10.3344/kjp.2007.20.2.230

A diagnosis of shoulder pain is varied and difficult to make. The initial onset of liver cancer is difficult to detect and patients typically do not complain of symptoms as most tumors are asymptomatic. If the symptoms of the patients develop, the first symptom is usually pain that extends from the abdomen to the back and shoulder. A suprascapular nerve block is used in the treatment of the referred shoulder pain due to a metastatic hepatoma, but the effectiveness of the treatment has been limited because of its short duration. Recently, the advent of pulsed radiofrequency (PRF) lesioning has proved a successful treatment for chronic refractory pain involving the peripheral nerves. We experienced a case of a 66-year-old male patient complaining of referred right shoulder pain due to metastatic liver cancer, which was relieved after PRF lesioning of the suprascapular nerve.
Abdomen ; Aged ; Carcinoma, Hepatocellular ; Diagnosis ; Humans ; Liver Neoplasms* ; Liver* ; Male ; Nerve Block ; Pain, Intractable ; Peripheral Nerves ; Shoulder Pain* ; Shoulder*

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Compression Fractures Diagnosed during the Treatment of Postherpetic Neuralgia : A case report.

Yong Min CHOI ; Hwa Yong SHIN ; Kang Joon LEE ; Mi Suk KOO ; Francis Sahn Gun NAHM ; Jeong Hun SUH ; Ji Yon JO ; Yong Chul KIM ; Sang Chul LEE

The Korean Journal of Pain.2007;20(2):224-229. doi:10.3344/kjp.2007.20.2.224

Vertebral compression fractures can occur due to trauma, a malignancy, or most commonly, osteoporosis. These fractures are frequently seen in elderly women; 30% of postmenopausal women are affected by vertebral compression fractures. These fragile fractures frequently result in both acute and chronic pain, but more importantly, are a source of increased morbidity and possibly, mortality. These injuries can be treated both conservatively and with surgery. The use of percutaneous vertebral augmentation offers a minimally invasive approach for the treatment of vertebral compression fractures. We experienced two cases of compression fractures diagnosed during the treatment of thoracic postherpetic neuralgia. Two patients suffering from postherpetic neuralgia with a sharp and stabbing pain in the thoracic dermatomes that was unresponsive to conservative treatment were transferred to our clinic. During the management of postherpetic neuralgia, we incidentally found thoracic compression fractures after obtaining fluoroscopic guided images. After a balloon kyphoplasty, the preoperative pain related to the postherpetic neuralgia was successfully relieved soon after the procedure, and there were no complications.
Aged ; Chronic Pain ; Female ; Fractures, Compression* ; Humans ; Kyphoplasty ; Mortality ; Neuralgia, Postherpetic* ; Osteoporosis

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Infectious Spondylitis following Kyphoplasty: A case report.

Dae Hyun JO ; Sa Hyun PARK ; Myoung Hee KIM ; Jung Ho SEOL

The Korean Journal of Pain.2007;20(2):219-223. doi:10.3344/kjp.2007.20.2.219

Vertebroplasty and kyphoplasty are well-known, useful techniques for the treatment of painful vertebral compression fractures. Although the risk associated with these procedures is low, serious complications can occur. Of these complications, infection is even rarer, however, when it does occur, it is difficult to manage and can become life-threatening. We describe here a case of infectious spondylitis with epidural inflammation that occurred after performing kyphoplasty in a patient who had a thoracic vertebra compression fracture. We reviewed other case and literatures. Extreme asepsis of the operating theater, screening and treatment for systemic infection prior to the procedure, as well as the use of appropriate antibiotic prophylaxis are strongly recommended when conducting kyphoplasty to prevent infection.
Antibiotic Prophylaxis ; Asepsis ; Fractures, Compression ; Humans ; Inflammation ; Kyphoplasty* ; Mass Screening ; Spine ; Spondylitis* ; Vertebroplasty

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Percutaneous Pediculoplasty and Balloon Kyphoplasty in a Vertebral Metastatic Cancer Patient: A case report.

Ji Yon JO ; Jeong Hoon SUH ; Hwa Yong SHIN ; Yong Min CHOI ; Moon Sun BANG ; Sang Chul LEE ; Yong Chul KIM

The Korean Journal of Pain.2007;20(2):213-218. doi:10.3344/kjp.2007.20.2.213

Percutaneous vertebroplasty and balloon kyphoplasty have been accepted as effective treatment modalities for vertebral compression fractures in patients with vertebral metastasis. However, when these procedures are conducted in patients with lytic lesions of the vertebral pedicle, polymethylmethacrylate leakage through the lytic lesions that occurs during percutaneous pediculoplasty can increase the procedural risks due to the immediate vicinity of neural structures. In spite of this risk, there are not many available reports on safer methods of pediculoplasty. Here we report a case of vertebral metastasis in which the pedicle infiltration of cancer was successfully treated by pediculoplasty using a bone filler device that contained thick bone cement during a balloon kyphoplasty procedure.
Fractures, Compression ; Humans ; Kyphoplasty* ; Neoplasm Metastasis ; Polymethyl Methacrylate ; Vertebroplasty

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Peripheral Neuropathy in a Patient with Churg-Strauss Syndrome: A case report.

Jun Hwa LEE ; Jeong Hyun LEE ; Young Kwon GO ; Won Hyung LEE

The Korean Journal of Pain.2007;20(2):208-212. doi:10.3344/kjp.2007.20.2.208

Although Churg-Strauss syndrome (CSS) is a rare disease that is generally associated with vasculitis, nerve involvement is also common in cases of CSS. A 48-year old man was diagnosed with a herniated disc at L4-5 and an annular tear at L5-S1 after complaining of pain and numbness in the left lower leg. Peripheral edema was observed during physical examination and the patient was diagnosed with CSS after a biopsy was conducted. In addition, electromyography and nerve conduction velocity revealed the presence of multiplex mononeuropathy, which indicated the pain and numbness was due to peripheral neuropathy caused by CSS. The symptoms were relieved after oral administration of prednisolone. This case indicates that when symptoms of peripheral neuropathy do not match the radiographic evidence other causes, such as CSS, must be considered.
Administration, Oral ; Biopsy ; Churg-Strauss Syndrome* ; Edema ; Electromyography ; Humans ; Hypesthesia ; Intervertebral Disc Displacement ; Leg ; Middle Aged ; Mononeuropathies ; Neural Conduction ; Peripheral Nervous System Diseases* ; Physical Examination ; Prednisolone ; Rare Diseases ; Vasculitis

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