Retroclival epidural hematoma is rare, with fewer than 30 cases reported in the literature. Almost all of the previously reported cases occurred in children, with only a few cases affecting adults. Among these adult patients, only two suffered from the associated occipital condyle fracture (OCF), which is another rare injury. The patient involved in this study suffered from retroclival epidural hematoma and unilateral occipital condyle fracture, as demonstrated on both CT and MRI scans. The patient also suffered from an associated right brachial plexus injury without any other neurological deficits, a condition that has not previously been reported. This paper reviews the underlying mechanisms of these rare injuries and seeks to form an understanding of them before proposing the mechanism of injury in the patient involved in the study

BACKGROUND/AIMS: While it is well established that acupuncture relieves somatic pain, its therapeutic effect on visceral pain such as irritable bowel syndrome (IBS) is unclear. We evaluated the effect of acupuncture in treating visceral hyperalgesia in an animal model. METHODS: Sprague-Dawley rats (n = 8 per group) with prior neonatal maternal separation stress were randomly allocated to receive 3-day treatment of either electroacupuncture (EA) or sham acupuncture at acupoint ST-36. Another group of rats without prior maternal separation was included as non-handled controls. Colorectal distension was performed on the day after acupuncture treatment. The 3 groups were compared for pain threshold as determined by abdominal withdrawal reflex and visceromotor response as measured by electromyogram. Colon, spinal cord, and brainstem were sampled for topographic distribution and quantitative assessment of serotonin and Fos expression by immunohistochemistry. RESULTS: Rats in EA group had significantly higher pain threshold compared to those in sham acpuncture group (25.0 +/- 5.7 mmHg vs 18.7 +/- 5.2 mmHg, p = 0.01) and it was comparable with that of non-handled treatment naive controls (29.4 +/- 9.3 mmHg, p = 0.28). They also had lower visceromotor response as measured by electromyogram compared to those received sham acupuncture at all colorectal distension pressures. EA significantly suppressed Fos expression in doral raphe nuclei of brainstem, superficial dorsal horn of spinal cord and colonic epithelium but suppressed 5-HT expression only in brainstem and spinal cord. CONCLUSIONS: Electro acupuncture attenuates visceral hyperlagesia through down-regulation of central serotonergic activities in the brain-gut axis.
Acupuncture ; Acupuncture Points ; Animals ; Axis, Cervical Vertebra ; Benzodiazepines ; Brain Stem ; Colon ; Down-Regulation ; Electroacupuncture ; Epithelium ; Horns ; Hyperalgesia ; Immunohistochemistry ; Irritable Bowel Syndrome ; Models, Animal ; Nociceptive Pain ; Pain Threshold ; Raphe Nuclei ; Rats ; Rats, Sprague-Dawley ; Reflex ; Salicylamides ; Serotonin ; Spinal Cord ; Visceral Pain