Prevalence of Neuropathic Pain and Patient-Reported Outcomes in Korean Adults with Chronic Low Back Pain Resulting from Neuropathic Low Back Pain

STUDY DESIGN: A noninterventional, multicenter, cross-sectional study. PURPOSE: We investigated the prevalence of neuropathic pain (NP) and patient-reported outcomes (PROs) of the quality of life (QoL) and functional disability in Korean adults with chronic low back pain (CLBP). OVERVIEW OF LITERATURE: Among patients with CLBP, 20%–55% had NP. METHODS: Patients older than 20 years with CLBP lasting for longer than three months, with a visual analog scale (VAS) pain score higher than four, and with pain medications being used for at least four weeks before enrollment were recruited from 27 general hospitals between December 2014 and May 2015. Medical chart reviews were performed to collect demographic/clinical features and diagnosis of NP (douleur neuropathique 4, DN4). The QoL (EuroQoL 5-dimension, EQ-5D; EQ-VAS) and functional disability (Quebec Back Pain Disability Scale, QBPDS) were determined through patient surveys. Multiple linear regression analyses were performed to compare PROs between the NP (DN4≥4) and non-NP (DN4 < 4) groups. RESULTS: A total of 1,200 patients (females: 65.7%; mean age: 63.4±13.0 years) were enrolled. The mean scores of EQ-5D, EQ-VAS, and QBPDS were 0.5±0.3, 55.7±19.4, and 40.4±21.1, respectively. Among all patients, 492 (41.0%; 95% confidence interval, 38.2%–43.8%) suffered from NP. The prevalence of NP was higher in male patients (46.8%; p < 0.01), in patients who had pain based on radiological and neurological findings (59.0%; p < 0.01), and in patients who had severe pain (49.0%; p < 0.01). There were significant mean differences in EQ-5D (NP group vs. non-NP group: 0.4±0.3 vs. 0.5±0.3; p < 0.01) and QBPDS (NP group vs. non-NP group: 45.8±21.2 vs. 36.3±20.2; p < 0.01) scores. In the multiple linear regression, patients with NP showed lower EQ-5D (β=−0.1; p < 0.01) and higher QBPDS (β=7.0; p < 0.01) scores than those without NP. CONCLUSIONS: NP was highly prevalent in Korean patients with CLBP. Patients with CLBP having NP had a lower QoL and more severe dysfunction than those without NP. To enhance the QoL and functional status of patients with CLBP, this study highlights the importance of appropriately diagnosing and treating NP.

Efficacy of Epidural Neuroplasty Versus Transforaminal Epidural Steroid Injection for the Radiating Pain Caused by a Herniated Lumbar Disc

OBJECTIVE: To compare the treatment effects of epidural neuroplasty (NP) and transforaminal epidural steroid injection (TFESI) for the radiating pain caused by herniated lumbar disc. METHODS: Thirty-two patients diagnosed with herniated lumbar disc through magnetic resonance imaging or computed tomography were included in this study. Fourteen patients received an epidural NP and eighteen patients had a TFESI. The visual analogue scale (VAS) and functional rating index (FRI) were measured before the treatment, and at 2 weeks, 4 weeks and 8 weeks after the treatment. RESULTS: In the epidural NP group, the mean values of the VAS before the treatment, and at 2 weeks, 4 weeks and 8 weeks after the treatment were 7.00+/-1.52, 4.29+/-1.20, 2.64+/-0.93, 1.43+/-0.51 and those of FRI were 23.57+/-3.84, 16.50+/-3.48, 11.43+/-2.44, 7.00+/-2.15. In the TFESI group, the mean values of the VAS before the treatment, and at 2 weeks, 4 weeks and 8 weeks after the treatment were 7.22+/-2.05, 4.28+/-1.67, 2.56+/-1.04, 1.33+/-0.49 and those of FRI were 22.00+/-6.64, 16.22+/-5.07, 11.56+/-4.18, 8.06+/-1.89. During the follow-up period, the values of VAS and FRI within each group were significantly reduced (p<0.05) after the treatment. But there were no significant differences between the two groups statistically. CONCLUSION: Epidural NP and TFESI are equally effective treatments for the reduction of radiating pain and for improvement of function in patients with a herniated lumbar disc. We recommend that TFESI should be primarily applied to patients who need interventional spine treatment, because it is easier and more cost-effective than epidural NP.

A case of bilateral Moyamoya disease associated with Williams syndrome

Bilateral Moyamoya disease manifesting as ischemic stroke in a patient with Williams syndrome has not been previously reported. Williams syndrome is a genetic disorder characterized by infantile hypercalcemia, elfi n facial features, an outgoing personality, and cardiovascular abnormalities. It has been found to be related to elastin gene defect. Cerebrovascular abnormalities with associated strokes in Williams syndrome have been described only recently and rarely. Moyamoya disease is a cerebrovascular disorder characterized by progressive occlusion of the supraclinoid internal carotid artery. The pathogenesis of Moyamoya disease is unclear. Only a single report of Moyamoya disease associated with Williams syndrome manifesting as an intracerebral hemorrhage has been published. We report the fi rst case of bilateral Moyamoya disease manifesting as ischemic stroke in a patient with Williams syndrome. We propose that inherited moyamoya disease is also related to elastin gene defect.

Ischemic Complication of Ruptured Anterior Choroidal Artery Aneurysm / 대한뇌혈관외과학회지

OBJECTIVE: Vasospasm is known to play the key role in determining the prognosis of aneurysmal subarachnoid hemorrhage (SAH). We have experienced a higher incidence of vasospasm in the cases of SAH caused by rupture of an anterior choroidal artery (AChA) aneurysm than aneurysms of other area. The purpose of this study is to analyze the ischemic complications in patients with a ruptured AChA aneurysm. METHODS: We retrospectively reviewed 13 patients who were treated for ruptured AChA aneurysm from 1994 to 2007 at our hospital. The prognosis and complications were analyzed based on the institution's data, gender, age, the Hunt and Hess grade, the Glasgow coma scale, the Glasgow outcome scale, the symptoms and neurological examinations, the medical treatment, the digital subtraction angiography (DSA), the computed tomography (CT) and the magnetic resonance imaging (MRI). RESULTS: Forty-one (6%) out of 678 SAH patients had ischemic complications. Thirteen cases (2%) were caused by rupture of an anterior choroidal artery (AChA) aneurysm and 3 of these 13 cases (23.1%) had ischemic complications. Two of these 3 cases (15.4%) had neurological abnormality. Twelve out of the 13 AchA aneurysms had the saccular form. CONCLUSION: In cases of SAH from ruptured AchA aneurysm, the probability of ischemic complications was higher than that of general aneurysmal SAH. This seems to be due to the thin AChA and that the vascular territory of AChA is the area where ischemic brain damage can occur even by a mild vasospasm. So, when operating on a AChA aneurysm, maximum effort should be done to preserve the AChA. However, in the exceptional case with multiple AChAs, one AChA can be trapped without a definitive neurological deficit.

A Case of Streptococcus salivarius Meningitis in a Patient with Cerebrospinal Fluid Rhinorrhea after Skull Base Fracture / 대한임상미생물학회지

Streptococcus salivarius meningitis is very uncommon, and most cases are iatrogenic, occurring after invasive procedures such as spinal anesthesia or lumbar puncture etc.. Post-traumatic occurrence of this infection is especially rare. A 20-year-old man with a previous history of skull base fracture was seen at the emergency department with signs of acute bacterial meningitis. The CSF had a few gram positive cocci with neutrophilic pleocytosis, which were identified as S. salivarius by the Vitek system (bioMerioux, Inc., Hazelwood, MO, USA), rapid ID 32 Strep (bioMerieux, Marcy-l'Etoile, France) and 16S rRNA sequencing. The microorganism showed intermediate resistance to penicillin (MIC=0.25 microg/mL) but was susceptible to cefotaxime (MIC=0.25 microg/mL) and vancomycin (MIC= 0.75 microg/mL). The patient was treated with ceftriaxone and vancomycin. He also had his CSF leakage repaired by an endoscopic approach. To our knowledge, this is the first case of S. salivarius meningitis reported in Korea.

A Clinical Analysis of Delayed Traumatic Intracerebral Hemorrhage

The occurrence of delayed intracerebral hemorrhage is more frequent than previously reported and is associated with a poor outcome. Early detection and proper management is important in that aspect. The progression tends to be insidious. When the patient's consciousness gets worse or is not improving within resonable time, the second CT scan should be performed. In a retrospective study of 211 consecutive patients with traumatic intracranial hematomas, we identified 12 cases(5.6%) with delayed traumatic intracerebral hemorrhage(DTICH). Among these, five(41.6%) died of DTICH. Cerebral contusion on initial CT, acceleration-deceleration injury with rotational forces, surgical decompression would be important contributors in the development of DTICH.