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

Meniscal cysts are cysts that occur as a direct extension, or within the substance of the meniscus. The incidence varies in reports from 1% to 20% and are much more common laterally. They usually present as joint-line pain, swelling, or both in young adult men, and are often associated with meniscal tears. The exact etiology of meniscal cysts is unknown. A myxoid degenerative process is identified histologically. There is often a history of precedent trauma. Diagnosis is often suspected clinically and can be confirmed by arthrogram, CT, or MRI when necessary. Conservative treatment in the patient with few symptoms is recommended. Should the cyst become significantly symptomatic, it is necessary to treat the meniscal pathology to prevent a cyst recurrence. At the present time it is our recommendation that this be done by arthroscopically resecting the meniscus back to normal meniscus and either aspirating and injecting the cyst with steroid or local cyst excision if the aspiration and injection fails. If no meniscal tear is documented at arthroscopy, exploration and excision of the cyst are recommended.
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PMID:Meniscal cysts. 219 79

The chronic infection following internal fixation may develop in a different pattern, according to the risk factor involved. There is no doubt that direct trauma on bone and soft tissue is an important risk factor. The pattern of each infection may differ according to the technique of internal fixation used, i.e. external fixator, plate or intramedullary nailing. The damages are minimized by using the appropriate technique. While bone necrosis in osteomyelitis is present, the pattern of it may be changing. An infected non-union may occur in osteomyelitis (osteitis) when present before bone-healing took place. Should infection overlast the bone-healing period, the localization of the main focus is determinant for the outcome of the infection. The assessment of an osteomyelitis consists in the evaluation of the patient's general aspect and the extension of the infectious disease. Assessing it by plain radiographs, it might be accompanied by leucocyte scanning, CT-scan or MRI. The indication of a more aggressive treatment of chronic osteomyelitis is given in all cases of infected nonunion, chronicle fistulation and in presence of pain and contractures. Antibiotics should only be used in addition to a surgical procedure.
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PMID:[Chronic infection following osteosynthesis]. 220 78

Vascular lesions of the cerebral cortex sparing the thalamus (MRI or CT with reconstructions) may be accompanied by burning or constrictive pain which suggests thalamic pain as it affects one half of the body and is associated with induced pain. Summation hyperpathia is rare; allodynia is more common and sometimes isolated (2 cases). Cortical pain may be paroxysmal, and in 3 of our patients it progressed like a jacksonian seizure. The territory of pain is also the site of global or spinothalamic hypoaesthesia (5 cases). Early SEPs are abolished or of low amplitude (8 cases). The lesion is located in area SI or extends to the thalamo-parietal radiations; in 11 out of 12 patients it was located in the minor hemisphere. Two physiopathological theories are discussed: hyperactivity of the intralaminar thalamus relieved from cortical inhibition, or denervation hyperactivity related to the cortical or subcortical lesion.
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PMID:[Cortical pain. Clinical, electrophysiologic and topographic study of 12 cases]. 220 86

The diagnosis and management of lumbar disc disease has undergone significant changes in recent years. This is especially true for diagnostic imaging studies (MRI and CT). Currently, CT/myelography or unenhanced MRI may be used to confirm the diagnosis and the level of involvement of lumbar disc disease. The indications for lumbar disc surgery include patients with neurologic deficits and/or those in whom intractable pain does not respond to conservative measures. Conventional disc surgery and/or microdiscectomy are both good operative procedures for lumbar disc disease, and each yields excellent results when criteria for diagnosis and surgery are strictly followed.
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PMID:Clinical aspects of lumbar intervertebral disc disease. 221 6

While there have been 5 cases of intraventricular arachnoid cyst published in the literature, the occurrence in the anterior horn of the lateral ventricle has not been reported. We report a case of intraventricular arachnoid cyst of the anterior horn causing attacks of orbital pain. A 30-year-old man was admitted with frequent attacks of orbital pain on his right side. Neurological examination revealed no abnormality. Plain CT showed a cystic dilatation of the anterior horn of the right lateral ventricle, and enhanced CT showed a deviation of the septal veins to the left side. T1-weighted MRI demonstrated a low-intensity mass in the anterior horn of the right lateral ventricle, and T2-weighted image demonstrated the mass as having high intensity. PEG in the sitting position showed no filling of air into the right lateral ventricle due to obstruction of the right foramen of Monro. The patient underwent an operation under a diagnosis of intraventricular benign cyst. The cyst wall was subtotally removed and the right foramen of Monro was opened. Histological examination of the specimen showed an arachnoid membrane with prolific collagen fibers. From an embryological point of view, the arachnoid membrane is derived from the arachnoid cell. We think intraventricular arachnoid cysts to originate from the remnants of the arachnoid cell on the tela choroidea or on the choroid plexus like intraventricular meningiomas.
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PMID:[Intraventricular arachnoid cyst appearing with attacks of orbital pain: case report and review of the literature]. 221 71

A 41-year-old male was admitted to our service with right occipital pain as his chief complaint. CT and MRI examinations revealed bilateral chronic subdural hematomas. The patient had also been affected with ITP since the age of 28. Since emergency operation was thought to be dangerous, he was transferred to Tokushima University Hospital, and treated preoperatively by administration of steroids and a large dose of immunoglobulin. When his platelet count had returned to 146,000/mm3, evacuation of the hematoma through burr holes was performed successfully under local anesthesia. The postoperative course was uneventful. So far as we have been able to find in the literature, only 3 cases of ITP complicated by chronic subdural hematoma have been reported. The characteristic clinical feature of these 4 cases including our own case was noted as the absence of a history of trauma. However, the etiological relationship between ITP and chronic subdural hematoma was controversial. Occurrence of chronic subdural hematoma in patients with ITP and in patients under hemodialyzer treatment is very rare. However, intracerebral hemorrhages are rather common among such patients. So it was suggested that the tendency to bleeding among patients with ITP, and among hemodialyzer patients may contribute little as an etiological factor in the evolution of chronic subdural hematoma.
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PMID:[A case of chronic subdural hematoma associated with idiopathic thrombocytopenic purpura (ITP)]. 221 72

The purpose of this study was to evaluate the natural history of morphologic changes within the lumbar spine in patients who sustained lumbar disc extrusions. All patients in this study were treated nonoperatively for radicular pain and neurologic loss. The following questions were addressed: 1) Does perithecal or perineural fibrosis result when extrusions are not removed surgically, and 2) Do disc extrusions spontaneously resolve, and, if so, how rapidly? The study population consisted of 11 patients with extrusions and radiculopathy. All patients were successfully treated nonoperatively. All had a primary complaint of leg pain and all had positive straight leg raising reproducing their leg pain at less than or equal to 60 degrees. Additionally, 87% had muscle weakness on a neurologic basis in a root level distribution corresponding to the site of disc pathology. Computed tomographic (CT) examinations were obtained on all patients at the inception of treatment. These studies were compared with follow-up MRI studies. The initial CT scans were evaluated for the following criteria: disc size and position, thecal sac effacement, nerve root enlargement or displacement, and evidence of central or intervertebral canal stenosis. In addition to the pathomorphology evaluated on the CT scans, follow-up MRI studies also evaluated disc hydration at the herniated and contiguous levels, and the presence of perithecal or perineural fibrosis. The following grading system was used to evaluate change in fragment size on the follow-up studies: Grade 1-0 to 50% decrease in size; Grade 2-50 to 75% decrease in size; Grade 3-75 to 100% decrease in size.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The natural history of lumbar intervertebral disc extrusions treated nonoperatively. 221 16

The clinical picture of spinal epidural hematoma is usually characterized by the sudden onset of pain and acute paraplegia within a few hours. The reports of chronic spinal epidural hematoma above the lumbar level is extremely rare. Here we added one case whose hematoma was at cervical level. A 31-year-old previously healthy male suffered from continuous sharp pain in the back of his neck about 10 weeks before admission. He took analgesic drugs and treated with head traction by his home doctor with minimal relief. 4 weeks later from onset progressive weakness and numbness appeared at his right hand and arm. Physical examination on admission revealed mild monoparesis and sensory disturbance in his right upper limb. There was hyporeflexia of both upper extremities. Magnetic resonance imaging (MRI; Hitachi 0.2 T) visualized a dorsal epidural space occupying lesion extending from C3 to Th1 vertebral body level. This revealed high signal intensity in T2 weighted image and mixed (low and iso) signal intensity in T1 weighted image corresponding to old hematoma. All his medication was stopped and he treated with collar brace, which improved his neurological status. 3 weeks later, he recovered fully and follow-up MRI revealed the total absorption of the hematoma. Left vertebral angiogram showed that a part of posterior cerebral venous blood drained to cervical vertebral plexus. This finding suggested his epidural bleeding was venous in origin. Rupture of internal vertebral venous plexus that has no valves was considered as the source of spinal epidural hematoma.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Chronic cervical epidural hematoma diagnosed by magnetic resonance imaging]. 224 80

Three tourists developed eosinophilic meningitis after visiting the Fijian Islands. Two had a severe and long lasting illness with chronic intractable pain. In one patient electrophysiological studies and MRI scan of the brain were abnormal and provided evidence of both radicular and cerebral parenchymal involvement by the most likely causative agent, Angiostrongylus cantonensis.
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PMID:Eosinophilic meningitis: cause of a chronic pain syndrome. 224 59

The purpose of this study was to examine electrophysiologic abnormalities, including motor-evoked potentials, in a patient with post-traumatic syringomyelia before and after syringopleural shunting. A patient with C5 quadriplegia presented with pain, ascending sensory loss, and new weakness in the left upper extremity two yr after spinal cord injury. MRI revealed a syrinx extending from C2 to T12. We measured central motor conduction times (CMCTs) to the biceps, median F-wave latencies, needle electromyography and motor nerve conduction studies. Six days before surgery, CMCTs were 9.0 ms on the left and 7.8 ms on the right (normal less than 8.0), median F-waves were absent on the left and needle EMG revealed evidence of denervation in the left biceps. Fifteen days after syringopleural shunting at the T7 level, CMCTs had dropped to 6.9 ms on the left and 4.6 ms on the right; the left median F-wave reappeared with a normal latency. Repeat MRI revealed the syrinx to be smaller in diameter. These results suggest that CMCTs measured from magnetic stimulation of the motor cortex may be useful in the diagnosis of post-traumatic syringomyelia, as well as for following such patients postoperatively.
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PMID:Motor-evoked potentials reflect spinal cord function in post-traumatic syringomyelia. 226 50


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