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

Benign tumors of the cervical spine are relatively infrequent but have a number of common characteristics that aid in the evaluation and treatment of these lesions. The tumors are most common in the first and second decades of life, presenting as pain, neck stiffness and torticollis. In approximately 70%, the lesions are visible on plain roentgenograms and the remainder are well visualized on bone scan and computed tomographic scan. The majority are present in the posterior elements and may be treated adequately with excisional biopsy by curettage. Stage 3 lesions are best treated by marginal excisional techniques and may require adjunctive techniques such as embolization or radiation therapy. The location of the lesion and extent of excision determine the necessity for fusion.
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PMID:Benign tumors of the cervical spine. 144 34

The incidence of adverse reactions following standard film or screen cervical myelography with iohexol in 32 adult outpatients was reported. Iohexol at a dose of 1,080-3,000 mg of iodine was administered via a lateral C1-C2 approach in 26 patients and via a lumbar route in 6 patients. All 32 patients underwent postmyelographic cervical spine computed tomography and were discharged after the procedure was completed. No adverse reactions occurred in 53.1% of patients. The most common adverse reaction was headache (31.3%); other minor adverse reactions included exacerbation of pre-existing pain (12.5%), neck stiffness (9.4%), and vomiting (6.3%). Good to excellent technical quality was seen on all myelograms and computed tomographic scans. Outpatient cervical myelography with iohexol appears to be a safe and cost-effective alternative to inpatient examination.
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PMID:Iohexol cervical myelography in adult outpatients. 177 64

Many patients with "whiplash syndrome" experience unrelenting neck stiffness and pain. This abnormal muscular tension is postulated to be causally related to a central disorder of postural control, which has evolved secondary to injury of the inner ear labyrinthine structures. Moving platform posturography was used to demonstrate the presence or absence of a static or dynamic equilibrium disorder in 48 patients who had experienced the oscillation forces induced by a rear-end automobile collision. Other vestibular tests were used to document dysfunction of the semicircular canals and the otolith structures. A high percentage of patients were found to have faulty inner ear functioning leading to inefficient muscular control of balance and erect posture. Active perilymph fistulas were identified at surgery in seven patients.
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PMID:Whiplash, postural control, and the inner ear. 192 43

Two cases of spinal subarachnoid haematoma occurring after spinal anaesthesia are reported. In the first case, lumbar puncture was attempted three times in a 81-year-old man; spinal anaesthesia trial was than abandoned, and the patient given a general anaesthetic. He was given prophylactic calcium heparinate soon after surgery. On the fourth day, the patient became paraparetic. Radioculography revealed a blockage between T10 and L3. Laminectomy was performed to remove the haematoma, but the patient recovered motor activity only very partially. The second case was a 67-year-old man, in whom spinal anaesthesia was easily carried out. He was also given prophylactic calcium heparinate soon after surgery. On the fourth postoperative day, pulmonary embolism was suspected. Heparin treatment was then started. Twelve hours later, lumbar and bilateral buttock pain occurred, which later spread to the neck. On the eighth day, the patient had neck stiffness and two seizures. Emergency laminectomy was carried out, which revealed a subarachnoid haematoma spreading to a level higher than T6 and below L1, with no flow of cerebrospinal fluid, and a non pulsatile spinal cord. Surgery was stopped. The patient died on the following day. Both these cases are similar to those previously reported and point out the role played by anticoagulants. Because early diagnosis of spinal cord compression is difficult, the prognosis is poor, especially in case of paraplegia.
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PMID:[Subarachnoid hematoma and spinal anesthesia]. 227 24

Nuchal symptoms were found in the majority of 100 consecutive patients with cluster headache. In 10%, pain was experienced in the neck with the initial typical orbitotemporal pain; in 37%, pain radiated from the orbit or temple to the ipsilateral side of the neck. Sometimes, neck pain heralded the onset of the attack by a few minutes. During an attack, neck stiffness was reported in 40% and tenderness in 29%. Movement of the neck, especially flexion, precipitated cluster headache in 9% of patients. This was particularly true of patients with chronic cluster headache. Neck movement aggravated the headache in 16 of 100 patients and an equal number reported amelioration of pain by neck movement, especially extension. The nuchal features did not necessarily accompany every attack and were usually overshadowed by the severity of the typical headache. Nevertheless, symptoms referable to the neck occur more commonly than is generally appreciated.
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PMID:Nuchal features of cluster headache. 237 Jan 35

Common clinical practice relies on the absence of neck stiffness or other meningeal signs to rule out meningitis in the alert, healthy adult. The literature does not address this specifically but implies that meningeal signs are reliable and usually present in awake patients, except infants, the elderly, and the immunosuppressed. In the following three cases two adults and a 4-year-old child, none of them immunosuppressed, presented with bacterial meningitis with no meningeal signs. In the first case, mental status was completely normal; in the second, there was only minor lethargy attributed to pain medication. In the third, lethargy was attributed to head trauma. In all three the diagnosis of meningitis was delayed up to 19 hours; lumbar puncture was performed while meningeal signs were still absent and cerebrospinal fluid analysis was grossly abnormal. All three patients had Streptococcus pneumoniae meningitis, and all three suffered massive brain damage within 24 hours of presentation and eventually died. Although the true incidence of absent meningeal signs in meningitis is unknown, the condition is rare. Clinicians cannot rely on the absence of neck stiffness to rule out meningitis, even in healthy and awake adults, and lumbar puncture should be performed whenever there is serious consideration of that diagnosis.
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PMID:Fulminant bacterial meningitis without meningeal signs. 291 Jan 68

Fractures of the atlas vertebra are generally considered to be innocuous injuries. A review of 35 patients with C1 fractures treated in the Acute Spinal Cord Injury Unit of Shaughnessy Hospital indicated that long-term morbidity is not as low as was previously thought. Thirteen of 23 patients (56%) followed up a minimum of 1 year post-trauma had significant symptoms of scalp dysesthesia, neck pain, and/or neck stiffness. A classification is presented, and the results of treatment modalities used are reviewed. Based on the findings, the simplest orthosis consistent with appropriate treatment of any of the often associated other spine fractures is recommended. Surgery is reserved for late instability or pain.
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PMID:Fractures of the atlas: classification, treatment and morbidity. 318 89

We present 3 new cases of cervical epidural abscess (CEA), a rare condition, along with a review of 12 other case reports. The average patient age was 45 years; just over half were male. The abscesses usually involved the mid to lower cervical region and extended an average of three to four segments. Neck stiffness was present in all patients; root pain and paresthesias were present less often. Weakness of one to four extremities developed in all but one patient. Sensory levels were frequently present, sometimes below the site of the lesion. All but two patients were febrile. All but two had elevated CSF protein, and all but two had a pleocytosis; myelography always revealed a complete or partial block. Staphylococcus aureus was the causative organism in 8 of 11 patients. CEA should be considered in a patient with neck stiffness, paresthesias, and/or radicular pain so that CT or myelography followed by surgical decompression and/or antimicrobial drugs can be initiated before prolonged weakness develops. One of our patients developed a syrinx causing a new neurologic deficit 3 years after treatment. Delayed syringomyelia, a rare complication of extramedullary lesions, lends support to vascular occlusion as the major mechanism of damage in epidural abscess.
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PMID:Cervical epidural abscess. 331

A new case of sub-occipital Pott's disease is reported: a 26 year old, coloured male patient from Senegal was admitted for: cervical pain of 6 month duration, neck stiffness, dysphagia, left XII paralysis and left hemiparesis. The radiological study found an anterior atlanto-axial subluxation, basilar impression, and increased thickness of the retropharyngeal soft tissue, lysis of the left occipital condyle and the left lateral mass. CT scan study revealed a retropharyngeal mass and an epidural contrast-enhanced lesion at the C2 C3 C4 levels. Chest-X ray showed one tuberculous lesion at the right apex. The research of Acid Fast Bacilli in gastric secretion samples and the results of the retropharyngeal mass puncture were positive. An antituberculous trichemotherapy was started. After early reduction by skull tongs traction, an occipito-cervical arthrodesis by Roy Camille plates was performed, followed by the wearing of a minerva plaster jacket and then a plastic collar. Each one for a 5 month period. One year later, there remained only a left XII paralysis, but the bony reconstruction was not yet obvious on tomography. A survey of the literature of 70 cases of sub-occipital Pott's disease has pointed out these findings: cervical pain (98%), neck stiffness (82%), Atlantoaxial subluxation (68%), thickened prevertebral soft tissue shadow (77%), lateral mass lysis (48%) other tuberculous focus (29%). The main therapeutic trends are: early and long-lasting antituberculous poly-chemotherapy, early reduction of subluxations, prolonged contention for slight osteolytic lesions and for major: lytic lesions, a posterior surgical procedure either by bone graft combined with wires or preferably fusion by means of occipito-cervical plates. The removal of abscess is discussed.
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PMID:[Suboccipital Pott's disease]. 344 87

To clarify the association of occupational cervicobrachial disorder (OCD), with labor conditions, and personal situation, a questionnaire study was conducted among nursery school teachers. The questionnaire was composed of subjective symptoms related to OCD (neck, shoulder, back and arm stiffness/pain), labor conditions, and whether or not the teacher had a child of her own under the age of two. Data of 793 subjects were analyzed. The results were as follows: The mean age and working period of 793 subjects were 27.6 (+/- 4.9) and 5.5 (+/- 3.2) years, respectively. Of them, 38.5% complained of right shoulder stiffness every day during the prior month, 26.5% neck stiffness, 18.8% arm stiffness, 9.6% back pain, 7.8% shoulder pain and 3.9% arm pain. The complaint rates on the left side were similar to those on the right side. The complaint rates of these subjective symptoms increased with the duration of the working period. The complaint rates of shoulder, neck and arm stiffness increased earlier than those of back stiffness, shoulder or arm pain. The complaint rates of these symptoms were highest among teachers in charge of children less than one-year-old and those in charge of four-year olds. Teachers in charge of three-year-old children had the lowest complaint rates. Subjects complaining of neck, shoulder and arm stiffness on every day worked under less favorable conditions than those without such complaints. When subjects having no children of their own under the age of two were matched in their ages and length of work history with those who have such children, the complaint rates of the two groups did not differ statistically for any of the subjective symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Occupational cervicobrachial disorder (OCD) of nursery school teachers based on subjective symptoms related to OCD]. 624 48


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