Cases reported "Phantom Limb"

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1/21. Diabetic neuropathic pain in a leg amputated 44 years previously.

    The mechanism of neuropathic pain in the diabetic limb is far from clear. phantom limb pain likewise is of obscure aetiology. The development of typical pain in an absent leg in a patient with diabetes many years after the amputation stimulates thought as to the mechanism, not only of neuropathic pain, but also of phantom limb pain. A 58-year-old man was diagnosed with type 2 diabetes 44 years after having undergone left below knee amputation for congenital AV malformation, at the age of 13. Eight months before the diagnosis of diabetes he began to complain of pain in the leg on the amputated side-pain very similar to that described in typical diabetic neuropathy. This was followed by similar pain in the right leg. MR scan of the spine revealed a small syringohydromyelia of the thoracic cord in addition to a prolapse of disc at L(5)/S(1) level on the left side, which was first noted 5 years previously. There were no other features of S(1) compression. The typical neuropathic character of the pain involving both the amputated and the intact limbs that developed with the diagnosis of type 2 diabetes suggest that the neuropathic pain may originate from centres higher than peripheral nerves.
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ranking = 1
keywords = nerve
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2/21. Phantom sensations in a patient with cervical nerve root avulsion.

    This case study reports detailed phantom sensations in a 35-yr.-old man who had his C5 and C6 cervical nerve roots avulsed from the cord during a motorcycle accident at the age of 22 years. The subject, who was left with a paralyzed right deltoid muscle, anesthetic sensation along the upper lateral portion of the right arm, and absent right biceps reflex, became aware of phantom right arm and hand sensations a few months after the original injury. This finding--which has important implications for understanding the process involved in bodily perception as well as the development of these perceptions--provides evidence of a distributed neural representation of the body that has both genetic and experiential determinants. The implications of these findings are discussed with reference to recent concepts of phantom limb experiences and related phenomena.
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ranking = 5
keywords = nerve
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3/21. phantom limb pain as a manifestation of paclitaxel neurotoxicity.

    paclitaxel is a chemotherapeutic agent with activity directed against several malignancies. It has multiple adverse effects including neurotoxicity. We describe 2 patients with prior amputation who experienced phantom limb pain (PLP) after receiving paclitaxel therapy. A third patient experienced disabling neurotoxicity in the extremity of a prior ulnar nerve and tendon transposition after receiving paclitaxel. This unique syndrome should be identified as a direct causal effect of paclitaxel. In this report, we review the pathophysiology of PLP and treatment options. physicians should be aware that PLP can occur after initiation of paclitaxel.
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ranking = 1
keywords = nerve
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4/21. Distressing upper extremity phantom limb sensation during intravenous regional anesthesia.

    BACKGROUND AND OBJECTIVES: The objective of this article is to describe a case of distressing upper extremity phantom limb sensation during intravenous regional anesthesia (IVRA). Case Report: A 33-year-old American Society of Anesthesiologists (ASA) status I female with an uncomplicated intrauterine gestation presented for endoscopic carpal tunnel release. Following gravity-assisted exsanguination of the vertically positioned left upper extremity, she underwent an IVRA. Within minutes of her arm being repositioned for surgery she remarked that the arm felt as if it was still in the vertical position. This sensory disturbance was described as fatiguing and exhausting. Despite reassurance and medication with intravenous narcotics, her symptoms became intolerable. Her phantom sensation disappeared upon dissipation of the IVRA. CONCLUSIONS: There are no previous reports regarding the development of phantom phenomena during an IVRA. The occurrence of distressing phantom sensations during an otherwise adequate IVRA may be interpreted as block failure and may lead to conversion to general anesthesia. Practitioners are encouraged to consider these phenomena when performing IVRA.
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ranking = 2.8756594905022
keywords = block
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5/21. An unusual case of chronic neuropathic pain responds to an optimum frequency of intravenous ketamine infusions.

    The effective treatment of patients suffering from a variety of difficult pain syndromes, including phantom pain and other neuropathic pains, remains a clinical challenge. Neuropathic pain has been shown to respond to drugs that block the N-methyl-D-aspartate (NMDA) receptor, such as ketamine and amantidine. A 44-year-old woman with a previous right-sided forequarter amputation presented to the Palliative medicine Team complaining of neuropathic pain in her left arm, which was neurologically intact. The pain was treated with repeated infusions of intravenous ketamine. Twenty-one infusions were given over a period of four months. The pain intensity experienced by the patient lessened as the frequency of the ketamine infusions increased. This finding has not been described previously and supports the theory that there may be an optimum frequency of ketamine infusions to achieve adequate pain control.
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ranking = 2.8756594905022
keywords = block
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6/21. phantom limb pain: a report of two cases.

    The efficacy of pre-emptive analgesia for phantom limb pain is still unclear. It is generally accepted that pre hyphen;amputation pain increases the incidence of phantom and stump pain, even if pre-emptive analgesia is performed before and during surgery and in the postoperative period. Two cases of traumatic upper limb amputations are described here with no pre-existing pain. Both received similar antinociceptive treatment by continuous block of the brachial plexus through infusion of ropivacaine 0.375% at 5 ml/h for 10 days. Treatment of case 1 was initiated immediately after surgery; however, this amputee developed intensive phantom limb pain which persisted at 6 months. Early use of the prosthesis after surgery was not possible for this patient. The intensity of phantom limb pain in case 2 decreased significantly after 6 months, even though brachial plexus blockade was not started until 5 weeks post-trauma. This patient used a functional prosthesis intensively beginning early after amputation. Serial magnetoencephalographic recordings were performed in both patients. Only case 2 showed significant changes of cortical reorganization. In case 1 markedly less cortical plasticity was found. A combination of relevant risk factors such as a painful neuroma, behavioural and cognitive coping strategies and the early functional use of prostheses are discussed as important mechanisms contributing to the development of phantom pain and cortical reorganization.
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ranking = 5.7513189810045
keywords = block
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7/21. Observations on the analgesic effects of needle puncture (acupuncture).

    The present study was undertaken in order to investigate the analgesic effect of needle puncture in a small self-selected group of patients with chronic or acute pain, and to examine the factors which determine success or failure of this treatment modality. We have found that in chronic painful conditions, needle puncture may be very effective in producing at least transient analgesia. It also can produce permanent relief of acute (self-limited) pains. Needle puncture was not helpful in the management of pain resulting from nerve damage. High score on psychometric indicators of anxiety and depression is a significant predictor os successful needle puncture analgesia in patients with chronic pain. Comparison of our results to studies of counterirritation indicate that the analgesia produced by needle puncture involves a mechanism similar to that of counterirritation-induced analgesia.
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ranking = 1
keywords = nerve
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8/21. phantom limb pain during labour.

    We report the occurrence of severe phantom limb pain during labour. The patient, a 27-year-old, had had an above knee amputation performed 6 years earlier following a road traffic accident but had no previous history of phantom limb phenomena. However, during early labour, she complained of a severe phantom limb pain in her amputated leg; a continuous epidural block relieved her of the sensation and pain. The sensation did not return following delivery.
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ranking = 2.8756594905022
keywords = block
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9/21. An unusual case of painful phantom-limb sensations during regional anesthesia.

    OBJECTIVE: The objective of this article is to describe a late-onset phantom-limb pain during a continuous analgesic popliteal nerve block after foot surgery and its alleviation and recurrence when stopping and resuming the local anesthetic infusion. CASE REPORT: A 29-year-old woman undergoing a left hallux valgus repair received a continuous popliteal sciatic nerve block for postoperative analgesia. Postoperatively, 6 hours after the commencement of a ropivacaine 0.2% infusion, she reported feelings of tingling, clenching pain, and missing-limb sensation below the ankle. The surgical site remained painless. sensation elicited by touch and propioception were normally perceived. Only sensations for pinprick and heat were impaired. The ropivacaine infusion was stopped, followed 2.5 hours later by the complete regression of any abnormal sensation. Meanwhile, pain at the surgical site was scored at 50 mm on a 100-mm visual analogic scale. As the infusion of ropivacaine was resumed, the abnormal sensations reappeared. The catheter was removed, and abnormal sensations again disappeared. The patient was discharged from hospital without further complications. CONCLUSIONS: This observation suggests that phantom-limb pain can be of late-onset and might occur during a continuous infusion of low-concentration local anesthetic responsible only for an analgesic block, as shown by the fact that only thermal and pinprick sensations, known to depend on Adelta-fibers and C-fibers, were altered. Therefore, this case contradicts the usual belief that a profound block is necessary to elicit phantom-limb pain.
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ranking = 436.20518662751
keywords = nerve block, block, nerve
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10/21. Disappearance of phantom limb pain during cauda equina compression by spinal meningioma and gradual reactivation after decompression.

    We describe a 65-yr-old woman, whose right lower limb had been amputated at the mid-femoral level because of complicated femur fracture sustained at the age of 5 yr. After amputation, she experienced phantom limb pain (PLP), which gradually decreased in intensity but persisted for 60 yr. At this point the pain diminished progressively, in parallel with the evolution of cauda equina compression caused by an intraspinal tumor. The PLP gradually reappeared over 3 mo after surgical removal of the tumor. IMPLICATIONS: We present a case in which phantom limb pain (PLP) in an amputated leg disappeared during cauda equina compression by meningioma and reactivated after surgical decompression. This case suggests that complete compression or blockade of nerves, a nerve plexus, the cauda equina, or the medullary cord may result in suppression of PLP, and decompression of or recovery from the block may cause reactivation.
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ranking = 7.7513189810045
keywords = block, nerve
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