ABSTRACT
BACKGROUND: Dystonia is uncommon in Tourette's syndrome, and occipital neuralgia secondary to Tourette's dystonia is more rare, affecting quality of life. Occipital peripheral nerve stimulation (PNS) is an excellent alternative by being adjustable and minimally invasive. Our case demonstrates occipital PNS as an effective option for refractory Tourette's dystonia. CASE PRESENTATION: A thirty-four-year-old male with poorly controlled Tourette's cervical dystonia presented with severe occipital neuralgia. Various medications were prescribed including propranolol and amitriptyline, and bilateral third-occipital nerve rhizotomies and occipital nerve blocks were trialed. Distal nerve blocks at the occipital protuberance were most effective. Therefore, an occipital PNS trial was done, and a PNS was implanted with no complications. Upon follow-up, the patient reported drastic pain reduction. CONCLUSION: Our case illustrates neuromodulation benefits for a rare presentation of refractory occipital neuralgia secondary to Tourette's-related dystonia. Occipital PNS should be considered for refractory cases because it is safe, easy to implant, and effective.
FUNDAMENTO: A distonia é incomum na síndrome de Tourette, e a neuralgia occipital secundária à distonia de Tourette é mais rara, afetando a qualidade de vida. A estimulação do nervo periférico occipital (SNP) é uma excelente alternativa por ser ajustável e minimamente invasiva. Nosso caso demonstra o SNP occipital como uma opção eficaz para a distonia de Tourette refratária. APRESENTAÇÃO DO CASO: Um homem de 34 anos com distonia cervical de Tourette mal controlada apresentou neuralgia occipital grave. Vários medicamentos foram prescritos, incluindo propranolol e amitriptilina, e foram testadas rizotomias bilaterais do nervo terceiro-occipital e bloqueios do nervo occipital. Os bloqueios dos nervos distais na protuberância occipital foram mais eficazes. Portanto, foi feito um ensaio de PNS occipital e um PNS foi implantado sem complicações. Após o acompanhamento, o paciente relatou redução drástica da dor. CONCLUSÃO: Nosso caso ilustra os benefícios da neuromodulação para uma apresentação rara de neuralgia occipital refratária secundária à distonia relacionada a Tourette. O PNS occipital deve ser considerado para casos refratários porque é seguro, fácil de implantar e eficaz.
Subject(s)
Humans , Male , Female , Patients/classification , Tourette Syndrome/complications , Peripheral Nerves/abnormalitiesABSTRACT
UNLABELLED: Percutaneous radiofrequency ablation (RFA) of the sphenopalatine ganglion (SPG) has been shown to be an effective modality of treatment for patients with intractable chronic cluster headaches (CHs). While the use of fluoroscopy for RFA of the SPG is common, to our knowledge there are no documented cases of procedures using cone beam computed tomography (CBCT) for image guidance. We present a case report of a patient suffering from chronic intractable CH with complete long-lasting relief after RFA of the SPG using CBCT. The case reaffirms the potential efficacy of RFA of the SPG in a case of chronic cluster headache as well as the use of CBCT as a superior alternative to bi-plane fluoroscopy for image guidance in the management of chronic CH. KEY WORDS: Cone beam computed tomography, sphenopalatine ganglion block, cluster headache, interventional pain, autonomic cephalalgia, radiofrequency ablation.
Subject(s)
Catheter Ablation , Cluster Headache/therapy , Ganglia, Parasympathetic , Cone-Beam Computed Tomography , HumansABSTRACT
Epidural steroid injections are a common procedure performed by pain physicians. The American Society of Regional Anesthesia along with several other groups recently provided guidelines for performing epidural injections in the setting of anticoagulants. We present a case of a patient who developed an epidural hematoma and subsequent paraplegia despite strict adherence to these guidelines. Although new guidelines serve to direct practice, risks of devastating neurologic complications remain as evidenced by our case.
Subject(s)
Analgesia, Epidural/adverse effects , Paraplegia/chemically induced , Paraplegia/diagnostic imaging , Steroids/adverse effects , Thoracic Vertebrae/diagnostic imaging , Female , Humans , Injections, Epidural/adverse effects , Middle Aged , Steroids/administration & dosage , Thoracic Vertebrae/drug effectsABSTRACT
Transient global amnesia (TGA) is a well-described neurological phenomenon. Clinically, it manifests with the sudden onset of a paroxysmal, transient loss of anterograde memory and disorientation but with intact consciousness. Typically, symptoms last for only a few hours. We present an unusual case of aortic dissection presenting with pure TGA in a patient, who had a positive outcome. This is the second case report of a patient with aortic dissection presenting with pure TGA syndrome, but it is the first case in which the patient survived.
