Metatarsalgia in a patient with chronic hemiparetic stroke managed with alcohol block of the tibial nerve: A case report

We report the case of a patient with a hemiparetic stroke whose metatarsalgia was successfully managed by reducing the spasticity of plantar flexor using neurolysis with 20% ethyl alcohol. A 57-year-old female patient with left hemiparesis following an infarct of the right corona radiata and basal ganglia one year previously presented with pain (numeric rating scale: 7) in the forefoot under the second to fourth metatarsal heads for six months. We diagnosed her with metatarsalgia and considered that the forefoot pain was associated with mechanical stress around the metatarsal head due to the spasticity (Modified Ashworth Scale: 1+) of the ankle plantar flexor. We performed neurolysis of the medial and lateral motor branches of the tibial nerve to the gastrocnemius muscle with 20% ethyl alcohol. After the alcohol block, foot pain and spasticity significantly reduced (numeric rating scale: 1; Modified Ashworth Scale: 0). Moreover, this effect persisted for at least three months. Clinicians should consider the possibility that spasticity can contribute to the development of foot pain in a patient with stroke.

Comparative Study on Cryosurgery with Carbamazepine and Alcohol injection in Trigeminal Neuralgia.

Objectives: To assess the efficacy of Cryosurgery for the treatment of Trigeminal neuralgia and to compare this procedure with Carbamazepine and alcohol block. Materials and method-A prospective study with 75 cases of Trigeminal neuralgia was carried out in the Department of Oral and Maxillofacial Surgery, Bangabandhu Sheikh Mujib Medical University from January 2006 to December 2007. Out of 75 cases 25 treated with Carbamazepine only, starting dose 100 mg b.d. with incremental dose up to 800 mg, 25 received alcohol block with maintenance dose of Carbamazepine 200 mg b.d. over the study period and 25 received Cryosurgery with initial maintenance dose of Carbamazepine 100 mg b.d. then tappered on 1st follow up visits and withdrawn on the 2nd follow up visits. Visual linear analogue scale (VAS) was used to measure pain intensity in different groups. Results: Out of different treatment modalities on follow up onwards pain control was better in Cryosurgery than Carbamazepine and alcohol block. Conclusion: This study reveals that the efficacy of Cryosurgery is better than Carbamazepine and alcohol block to eliminate the pain intensity in Trigeminal neuralgia.