Idiopathic hypertrophic pachymeningitis presenting with occipital neuralgia

BackgroundAlthough occipital neuralgia is usually caused by degenerative arthropathy, nearly 20 other aetiologies may lead to this condition.MethodsWe present the first case report of hypertrophic pachymeningitis revealed by isolated occipital neuralgia.

Results and conclusions

Idiopathic hypertrophic pachymeningitis is a plausible cause of occipital neuralgia and may present without cranial-nerve palsy. There is no consensus on the treatment for idiopathic hypertrophic pachymeningitis, but the usual approach is to start corticotherapy and then to add immunosuppressants. When occipital neuralgia is not clinically isolated or when a first-line treatment fails, another disease diagnosis should be considered. However, the cost effectiveness of extended investigations needs to be considered.     

多发孤立性浆细胞瘤伴维生素D缺乏

多发孤立性浆细胞瘤(MSP)发病率低,相关报道罕见。本文报道1例63岁女性患者,右下肢针刺样疼痛2月余,伴麻木、乏力。实验室检查提示高甲状旁腺激素血症,血清骨源性碱性磷酸酶升高,维生素D缺乏。神经肌电图显示右下肢神经源性损害。骶椎、骨盆CT增强提示骶1椎体右侧见软组织团片灶,呈膨胀性骨质破坏,骨皮质破裂。18 F-FDF PET/CT显示胸骨、胸、腰椎椎体、左侧髂骨及右侧骶骨骨质破坏影。CT引导下经皮穿刺活检免疫组化显示浆细胞骨髓瘤、CD138(+)、MUM-1(+)、Lambda(+)。结合骨髓涂片等结果该病例诊断为多发孤立性浆细胞瘤。     

Dietary constituent genistein inhibits the hyperexcitability of trigeminal nociceptive neurons associated with mechanical hyperalgesia following orofacial inflammation

ObjectivesGenistein, a dietary constituent, modulates voltage-dependent and ligand-gated ionic channels, suggesting that it could also attenuate inflammatory hyperalgesia. However, the mechanism underlying how genistein affects inflammation-induced hyperexcitability of nociceptive neurons in vivo remains to be determined. The present study therefore investigated whether administration of genistein could attenuate the inflammation-induced hyperexcitability of trigeminal spinal nucleus caudalis (SpVc) neurons associated with mechanical hyperalgesia in vivo.MethodsInflammation was induced by injection of complete Freund's adjuvant into the whisker pad. The mechanical thresholds for escape behavior and electrophysiological single-unit recording of SpVc neurons responding to mechanical stimulation were then conducted in naïve rats, inflamed rats, and inflamed rats with genistein administered intraperitoneally.ResultsThe lowered mechanical threshold in the inflamed rats was returned to control level following administration of genistein for 2 days. The mean number of discharge frequencies of SpVc neurons in inflamed rats was significantly decreased after genistein administration with both non-noxious and noxious mechanical stimuli. The increased spontaneous discharges of SpVc neurons in inflamed rats were significantly decreased after genistein administration. Noxious pinch-evoked after-discharge frequency and occurrence in inflamed rats was also significantly diminished after genistein administration, and expansion of the receptive field was significantly returned to control levels in inflamed rats.ConclusionHerein, we present the first evidence that genistein attenuates hyperexcitability of SpVc neurons associated with inflammatory mechanical hyperalgesia. These findings suggest that genistein could be a potential therapeutic agent in complementary alternative medicine for the prevention of trigeminal inflammatory hyperalgesia.     

Nummular headache in a patient with ipsilateral occipital neuralgia—A case report

Nummular headache (NH) is a rarely recognized primary headache, the diagnostic criteria of which are contained in the appendix to the 2nd edition of the International Classification of Headache Disorders (code A13.7.1).We present the case of a 61-year-old female who suffers, regardless of NH, from right-sided occipital neuralgia. The applied treatment – gabapentin and mianserin – had no effect. Injection of bupivacaine twice to the right occipital region resulted in neuralgia resolution up to three months, with no effect on NH.This confirms the independence of two abovementioned head pain conditions.     

心理应激后三叉神经运动核神经元两种谷氨酸受体亚单位表达变化的实验研究

目的 观察心理应激对大鼠三叉神经运动核(trigeminal motor nucleus,Mo5)内神经元谷氨酸受体亚单位N-甲基-D-天门冬氨酸受体-1型(N-methyl-D-aspartate receptor-1,NR-1)和α-氨基-3-羧基-5-甲基-4-异恶唑丙酸受体-2型(glutamic acid receptor-2,GluR-2)表达的影响,探讨心理应激在夜磨牙症中可能的作用机制.方法 选取健康雄性SD大鼠80只,按体质量分层后根据随机数字表随机分为心理应激组和空白对照组(各40只),采用荧光免疫组化和反转录聚合酶链反应检测心理应激1、4、8和12 d大鼠Mo5内NR-1和GluR-2的表达差异.结果 8和12d时心理应激组大鼠Mo5内GluR-2免疫荧光吸光度值(0.152 ±0.056、0.125±0.076)显著低于空白对照组(0.352±0.104、0.342 ±0.100)(P＜0.05),其mRNA水平(0.566±0.101、0.384±0.097)也显著低于空白对照组(0.913±0.095、0.892 ±0.099) (P ＜0.05);而NR-1的免疫荧光吸光度值及mRNA水平可见增高趋势,但与空白对照组差异无统计学意义(P＞0.05).结论 心理应激可导致大鼠Mo5内GluR-2表达发生改变,这一改变可能通过支配颌面部肌肉的运动神经元兴奋性的变化,进而影响口颌功能.     

射频温控热凝术治疗原发性三叉神经痛648例临床分析

目的:总结射频温控热凝术治疗648例原发性三叉神经痛患者的疗效和体会,探讨射频温控热凝术的方法、技巧和手术并发症的处理。方法:对2001年7月—2011年3月在我院分别采用眶下孔入路法、侧入路法、前入路法和其他入路进行射频治疗的648例原发性三叉神经痛患者临床疗效进行分析。结果:648例原发性三叉神经痛患者接受射频治疗,首次止痛率分别为眶下孔法98.3%、侧路法91.0%、前路法95.5%,首次射频治疗总有效率为96.0%,经6个月～2 a随访到的395例患者中,1年内复发率为9.6%,2年内复发率为20.5%,经再次射频治疗或手术治疗均获得完全止痛。结论:射频治疗原发性三叉神经痛疗效可靠,操作简便、适应证广、并发症较少,CT定位能提高穿刺精确度,减少并发症。     

MRTA对三叉神经痛患者微血管减压术后疗效的预测

目的:评价磁共振体层血管成像(MRTA)对预测三叉神经痛患者微血管减压术(MVD)后疗效的价值.方法:277例行MVD的三叉神经痛患者手术前、后接受MRTA检查,由2名影像医师分别读取术前及术后NVC分级,术后疗效分为优、良和差3组,采用SPSS 13.0软件包中的x2检验确定术前NVC的压迫程度、术后NVC压迫程度和术后NVC的缓解度在3组的分布有无差异.结果:250例(90.2％)病例术后2年疗效为优,18例(6.5％)为良,8例(2.9％)为差,1例(04％)因术后颅内出血死亡.术前不同NVC分级的病例,术后疗效无显著差异(x2=5.542,P=-0.476);术后不同NVC分级(x2=18.693,P＜0.05)和不同NVC缓解度(x2=11.484,P＜0.05)的病例,术后疗效有显著差异.结论:MVD术后行MRTA检查,是预测术后疗效较为有效的方法之一,术后NVC分级越大和NVC缓解度越小的病例,MVD术后疼痛缓解不佳的可能性越高.     

P2Y受体与三叉神经痛之间的关系

腺苷三磷酸(ATP)作为一种重要的神经递质具有广泛的生物学效应。多种伤害性刺激均可引起三叉神经节(TG)神经元释放ATP,ATP激活P2受体可引起疼痛。P2受体又分为P2X和P2Y两类。在受损的TG神经元上,P2Y受体的表达明显增多。本文就ATP与P2Y受体表达间的相关性、P2Y受体在TG中的信号转导机制、P2Y受体对神经损伤性痛觉信号的转导作用等研究进展作一综述。     

神经导航引导经皮穿刺三叉神经半月节射频热凝治疗三叉神经痛的研究

目的 探讨神经导航引导下经皮穿刺三叉神经半月节射频热凝术在治疗三叉神经痛中的应用.方法 选取我科神经导航引导下经皮穿刺三叉神经半月节射频热凝治疗的156例患者资料.所有患者术前均经头部3D-CT薄层连续平扫,并将影像资料导入SteahhStation Tria Plus手术导航系统,图像经三维重建后,确认患侧卵圆孔作为靶点,在导航实时引导下进行卵圆孔穿刺,并行电生理测试,再次确认靶点的位置无误后,进行射频热凝治疗.结果 所有患者顺利穿刺成功,射频热凝术后,患者原有的面部疼痛均明显缓解或消失,术前患者VAS评分为9.67±0.47,术后VAS评分为0.22±0.57,差异有明显的统计学意义,且所有患者术后均无严重并发症.结论 神经导航引导下经皮穿刺三叉神经半月节射频热凝术是一种微创,安全和疗效显著的三叉神经痛外科治疗手段.