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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The patient had lower lumbar arachnoiditis as part of a failed back surgery syndrome. Two years after discectomy, she still suffered from left lumbosciatic pain despite various invasive treatments. Psychologic impairment could be excluded. Finally, intrathecal morphine was infused at the D12 level. Small amounts of morphine (500-750 mg daily) introduced intolerable vomiting, which could not be prevented by antiemetics, so intrathecal sufentanil was started. A daily dose of 25 mg of sufentanil diluted in 1.5 ml of saline evoked hyperalgesia in the lower part of the body. Increasing the dose to 50 mg daily could only be supported for 3 h. Sufentanil was stopped and saline started, after which the evoked hyperalgesia disappeared. It is concluded that relatively high doses of sufentanil may induce hyperalgesia in patients with arachnoiditis and neuropathic pain.
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PMID:Hyperalgesia induced by high-dose intrathecal sufentanil in neuropathic pain. 910 Jan 84

The greatest costs associated with lower back pain occur in patients who have pain longer than three months and those with recurrent episodes of disabling pain. For these groups, evaluation by MR imaging is critical because it provides evidence for continued pain and functional incapacitation in 19% of cases. The causes of delayed recurrence of lower back and sciatic pain are multiple and include arachnoiditis, epidural fibrosis, facet osteoarthritic degenerative change, instability, new intervertebral disc herniation, spinal stenosis (lateral or central, from postoperative bony overgrowth), and vertebral osteomyelitis.
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PMID:MR imaging of the postoperative lumbar spine. 1049 32

Split cord malformations (SCMs) may occur in conjunction with myelomeningoceles, and are often ignored or misdiagnosed, potentially causing spinal cord tethering. In this paper, we study the incidence and clinical significance of such an association. We have retrospectively reviewed the medical records and radiographs of 20 myelomeningocele patients who had a SCM. These comprised at least 6% of our myelomeningocele patients. Five of the 20 had simultaneous repair of both lesions at birth. The other 15 were diagnosed with the SCM in a delayed fashion (mean age 4.4 years). Clinical presentations that prompted a diagnostic investigation included hypertrichosis (1), pain (2), routine radiographic follow-up (2), neurourological deterioration (10) and progressive scoliosis (5). In 17 of the 20 patients, the SCM involved the placode or was within one level of it. Fifteen of these were in the area of the placode or one segment above it. Five of the 20 patients had hypertrichosis and 15 of the 20 patients had a bony midline septum (i.e. type I SCM). Several accompanying spinal dysraphic lesions also contributed to the tethering: thickened (previously inconspicuous) filum terminale (6), syringohydromyelia (5) and a neurenteric cyst with a benign teratoma (1). Arachnoiditis secondary to the prior myelomeningocele repair was found, as expected, in all 15 patients. However, in virtually all patients, there was also evidence of tethering at the level of the SCM. Long-term follow-up showed stabilization of preoperative symptoms and signs, whereas complications of the operation and clinical evidence of retethering were uncommon. Myelomeningocele patients should be screened with clinical examinations looking for hypertrichosis and with spinal radiographs preoperatively looking for evidence of SCM (bony midline septum and/or interpedicular widening not due to the myelomeningocele). Intraoperatively, the placode and the rostral spinal cord segment should be carefully inspected for an SCM and other dysraphic lesions.
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PMID:Split cord malformations in myelomeningocele patients. 1091 95

It is generally accepted that chronic adhesive lumbar arachnoiditis is a cause of symptoms, notably back pain and/or pain (of almost any type, not necessarily 'anatomical') in the lower limbs, although there is no clearly defined clinical pattern which is clearly associated with this syndrome. There is no doubt that arachnoiditis occurs as a pathological and radiological entity due to a number of causes. In the view of the present authors, the nexus between the pathology and radiology on the one hand, and the patients' symptoms on the other hand, has not been demonstrated with any degree of scientific rigor.
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PMID:Symptomatic lumbar spinal arachnoiditis: fact or fallacy? 1094 59

The aim of this paper is to demonstrate the unusual MR features of thoracic syringomyelia following TB meningitis and to discuss the neurosurgical aspect of the treatment of this rare entity. Four years after a TB meningitis episode, a 30 year-old female patient developed a progressive spastic paraparesis. MR studies revealed multiloculated syrinxes throughout the thoracic cord. She had a syringo-subarachnoid shunt with a silastic "T" tube inserted. On the first postoperative day, she showed a dramatic neurological improvement, but unfortunately her paraparesis progressed to the preoperative level within a month despite diminished size of the syrinxes on the control MRI examination. Two and a half years after the operation the patient complained of having a burning type of central pain, and further deterioration in neurological function. Thoracic spinal MRI examination demonstrated enlarged syringomyelic cavities. At the second operation syringo-peritoneal shunt insertion was performed via right T10-11 hemilaminectomy using a "T" tube. At present, 4 months after the second operation, the patient's neurological examination demonstrated decreased spasticity, and improved strength in the legs compared to the preoperative level. MRI is the first choice of investigation in detecting TB related myelopathy as it provides a greater detail of pathological changes within and around the spinal cord such as syrinx formation and arachnoiditis. The MR findings are also helpful in deciding the management and predicting the outcome. Presence of multifocal loculations and arachnoid adhesions is the likely cause of treatment failures and poor prognosis.
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PMID:Syringomyelia--as a late complication of tuberculous meningitis. 1108 34

We report the case of a 42-year-old woman with a racemous cystecercus in the right cerebellopontine angle (CPA), who presented with bilateral trigeminal neuralgia. The parasite was completly removed via a right suboccipital craniotomy. On the first postoperative day, the patient indicated that the pain disappeared. The neuralgia was caused by two probable mechanisms: a distortion of the brain stem and compression of the nerve against an arterial loop at the entry zone or arachnoiditis caused by the parasite in the both CPA cisternae. This case demonstrates the advisability of obtaining imaging studies in all patients with trigeminal neuralgia before starting any management. We must always remind that the cysticercus may be a differential diagnosis of CPA lesions.
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PMID:[Unusual cause for bilateral trigeminal neuralgia: unilateral racemous cysticercus of cerebellopontine angle. Case report]. 1110 87

Magnetic resonance (MR) imaging is an excellent technique for evaluating the postoperative spine when the patient has chronic or recurrent symptoms. Potential causes of pain following lumbar surgery include arachnoiditis, stenosis, epidural fibrosis and disc herniations, pseudomeningocele, and infection. The postoperative cervical spine may be complicated by hematoma, canal or foraminal stenosis, disc herniation, and cord abnormality. This article reviews standard imaging protocols, the normal postoperative appearance of the spine, and the characteristic imaging findings for each of the abnormal postoperative conditions.
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PMID:Magnetic resonance imaging of the postoperative spine. 1137 19

Brown-Sequard syndrome (BSS) is a unilateral cord injury characterised by an ipsilateral motor deficit with contralateral pain and temperature hypoaesthesia. Although there are a variety of causes, the majority of cases are generally of neoplastic origin or are traumatic in origin. We describe a rare cause of Brown-Sequard syndrome as a result of post-traumatic arachnoiditis. Magnetic resonance imaging with the use of thin-slice high-resolution constructive interference in steady state (CISS) and T2-weighted spin-echo sequence were used to demonstrate the cause and appearance of the lesion in the spinal canal and was useful in the assessment and management of the patient. This case illustrates the usefulness of the CISS sequence in MRI for elucidating arachnoiditis.
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PMID:Post-traumatic arachnoiditis: an unusual cause of Brown-Sequard syndrome. 1170 36

Radiculomyelitis (arachnoiditis) (RMA) is a severe complication of tuberculous meningitis (TM). Two patients with HIV infection and TM are here reported. These patients developed RMA. In Spain only four cases of RMA have previously been reported (only one of them was HIV-positive). Clinical manifestations (subacute paraplegia, radicular pain, sensitive level and neurogenic bladder) are reported. Cerebrospinal fluid had inflammatory features, wit predominance of mononuclear cells and remarkable increase in protein content. Magnetic resonance imaging (MRI) is the most suitable diagnostic method. The therapeutic possibilities of this complication are discussed.
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PMID:[Arachnoiditis and intraspinal lesion. Complications of tuberculous meningitis in 2 patients with human immunodeficiency virus infection]. 1181 24

Steroids, drugs with potent antiinflammatory properties on the damaged nervous roots, have been especially used as adjuvants of local anesthetics, by spinal route, in the treatments of low-back pain. Spinal route was chosen to obtain a higher local concentration of drug, with few systemic side effects and to improve drug's action mechanism. Steroids seem to interact with GABA receptors and thus control neural excitability through a stabilising effect on membranes, modification of nervous conduction and membrane hyperpolarization, in supraspinal and spinal site. Epidural steroids are especially used in the treatment of low back pain due to irritation of nervous roots. They have been administered alone or in association with local anesthetics and/or saline solution. Slow release formulations have been generally used (methylprednisolone acetate, and triamcinolone diacetate). Other indications of epidural steroids are: postoperative hemilaminectomy pain, prevention of post herpetic neuralgia, degenerative ostheoartrithis. Intra-thecal steroids have been frequently used in the treatment of lumbar radiculopathy due to discopathy, as an alternative treatment when epidural administration is ineffective. Positive results have been obtained with methylprednisolone acetate, alone or in association with local anesthetics. Complications related to intraspinal steroids injections are due to execution of the block and side effects of drugs. Complications associated with intrathecal steroids are more frequent and severe than epidural injections and include: adhesive arachnoiditis, aseptic meningitis, cauda equina syndrome. Steroidal toxicity seems to be related to the polyethylenic glycole vehicle. Anyway, slow release formulations contain less concentrated polyethylenic glycole. The epidural administration, a correct dilution of steroid with local anesthetics solution and/or saline solution, and a limited number of injections (no more than three) allows a significant reduction of steroid neurotoxicity.
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PMID:[Clinical use of spinal or epidural steroids]. 1224 93


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