Abstract
Study design:
Case report of a 42-year-old woman with non-evoked pain diagnosed with a cavernous C7-Th6 spinal haemangioma.
Objectives:
To assess the effect of intramedullary haemorrhage (IH) on nociception and neuropathic pain (NP) at and below an incomplete spinal cord injury (SCI).
Setting:
Sensorimotor Function Group, Hospital Nacional de Parapléjicos de Toledo (HNPT).
Methods:
T2*-susceptibility weighted image (SWI) magnetic resonance imaging (MRI) of spinal haemosiderin and a complete pain history were performed 8 months following initial dysaesthesia complaint. Thermal pain thresholds were assessed with short 1 s stimuli, while evidence for central sensitization was obtained with psychophysical electronic Visual Analogue Scale rating of tonic 10 s 3 °C and 48 °C stimuli, applied at and below the IH. Control data were obtained from 10 healthy volunteers recruited from the HNPT.
Results:
Non-evoked pain was present within the Th6 dermatome and lower legs. T2*-SWI MRI imaging detected extensive haemosiderin-rich IH (C7-Th5/6 spinal level). Cold allodynia was detected below the IH (left L5 dermatome) with short thermal stimuli. Tonic thermal stimuli applied to the Th6, Th10 and C7 dermatomes revealed widespread heat and cold allodynia.
Conclusion:
NP was diagnosed following IH, corroborated by an increase in below-level cold pain threshold with at- and below-level cold and heat allodynia. Psychophysical evidence for at- and below-level SCI central sensitization was obtained with tonic thermal stimuli. Early detection of IH could lead to better management of specific NP symptoms, an appreciation of the role of haemorrhage as an aggravating SCI physical factor, and the identification of specific spinal pathophysiological pain mechanisms.
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References
Vierck CJ, Light AR . Effects of combined hemotoxic and anterolateral spinal lesions on nociceptive sensitivity. Pain 1999; 83: 447–457.
Dey DD, Landrum O, Oaklander AL . Central neuropathic itch from spinal-cord cavernous hemangioma: a human case, a possible animal model, and hypotheses about pathogenesis. Pain 2005; 113: 233–237.
Treede RD, Jensen TS, Campbell JN, Cruccu G, Dostrovsky JO, Griffin JW et al Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology 2008; 70: 1630–1635.
Finnerup NB, Gyldensted C, Fuglsang-Frederiksen A, Bach FW, Jensen TS . Sensory perception in complete spinal cord injury. Acta Neurol Scand 2004; 109: 194–199.
Hari AR, Wydenkeller S, Dokladal P, Halder P . Enhanced recovery of human spinothalamic function is associated with central neuropathic pain after SCI. Exp Neurol 2009; 216: 428–430.
Wasner G, Lee BB, Engel S, McLachlan E . Residual spinothalamic tract pathways predict development of central pain after spinal cord injury. Brain 2008; 131: 2387–2400.
Vierck CJ, Cannon RL, Fry G, Maixner W, Whitsel BL . Characteristics of temporal summation of second pain sensations elicited by brief contact of glabrous skin by a preheated thermode. J Neurophysiol 1997; 78: 992–1002.
King CD, Wong F, Currie T, Mauderli AP, Fillingim RB, Riley JL . Deficiency in endogenous modulation of prolonged heat pain in patients with Irritable Bowel Syndrome and Temporomandibular Disorder. Pain 2009; 143: 172–178.
Maynard FM, Bracken MB, Creasey G, Ditunno JF, Donovan WH, Ducker TB et al International standards for neurological and functional classification of spinal cord injury. American Spinal Injury Association. Spinal Cord 1997; 35: 266–274.
Comisión de la Sociedad Española de Neurofisiología Clínica. (A practical guide to carrying out neurophysiological monitoring in spine surgery). Rev Neurol 2004; 38: 879–885.
Bohannon RW, Smith MB . Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 1987; 67: 206–207.
Penn RD, Kroin JS . Long-term intrathecal baclofen infusion for treatment of spasticity. J Neurosurg 1987; 66: 181–185.
Defrin R, Shachal-Shiffer M, Hadgadg M, Peretz C . Quantitative somatosensory testing of warm and heat-pain thresholds: the effect of body region and testing method. Clin J Pain 2006; 22: 130–136.
Melzack R . The short-form McGill Pain Questionnaire. Pain 1987; 30: 191–197.
Perez C, Galvez R, Huelbes S, Insausti J, Bouhassira D, Diaz S et al Validity and reliability of the Spanish version of the DN4 (Douleur Neuropathique 4 questions) questionnaire for differential diagnosis of pain syndromes associated to a neuropathic or somatic component. Health Qual Life Outcomes 2007; 5: 66.
Lobo A, Ezquerra J, Gómez-Burgada F, Sala JM, Seva-Díaz A . El Mini-Examen Cognoscitivo: Un test sencillo y práctico para detectar alteraciones intelectuales en pacientes médicos. Actas Luso Esp Neurol Psiquiatr Cienc Afines 1979; 3: 189–202.
Povedano M, Gascón J, Gálvez R, Ruiz M, Rejas J . Cognitive function impairment in patients with neuropathic pain under standard conditions of care. J Pain Symptom Manage 2007; 33: 78–89.
Spielberger CD, Gorsuch RL, Lushene RE . Cuestionario de ansiedad estado-rasgo (STAI). Madrid: TEA, 1988.
Dworkin RH, Turk DC, Farrar JT, Haythornthwaite JA, Jensen MP, Katz NP et al Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain 2005; 113: 9–19.
Baumann CR, Schuknecht B, Lo Russo G, Cossu M, Citterio A, Andermann F et al Seizure outcome after resection of cavernous malformations is better when surrounding hemosiderin-stained brain also is removed. Epilepsia 2006; 47: 563–566.
Sadrzadeh SM, Anderson DK, Panter SS, Hallaway PE, Eaton JW . Hemoglobin potentiates central nervous system damage. J Clin Invest 1987; 79: 662–664.
Wang J, Dore S . Inflammation after intracerebral hemorrhage. J Cereb Blood Flow Metab 2007; 27: 894–908.
Hall ED . The role of oxygen radicals in traumatic injury: clinical implications. J Emerg Med 1993; 11: 31–36.
Gwak YS, Hulsebosch CE . Remote astrocytic and microglial activation modulates neuronal hyperexcitability and below-level neuropathic pain after spinal injury in rat. Neuroscience 2009; 161: 895–903.
Bao F, Fleming JC, Golshani R, Pearse DD, Kasabov L, Brown A et al A selective phosphodiesterase-4 inhibitor reduces leukocyte infiltration, oxidative processes, and tissue damage after spinal cord injury. J Neurotrauma 2011; 28: 1035–1049.
Kwon BK, Stammers AM, Belanger LM, Bernardo A, Chan D, Bishop CM et al Cerebrospinal fluid inflammatory cytokines and biomarkers of injury severity in acute human spinal cord injury. J Neurotrauma 2009; 27: 669–682.
Griffin RS, Costigan M, Brenner GJ, Ma CH, Scholz J, Moss A et al Complement induction in spinal cord microglia results in anaphylatoxin C5a-mediated pain hypersensitivity. J Neurosci 2007; 27: 8699–8708.
Vogel C, Stallforth S, Sommer C . Altered pain behavior and regeneration after nerve injury in TNF receptor deficient mice. J Peripher Nerv Syst 2006; 11: 294–303.
Hao JX, Kuypers RC, Xu XJ . Response characteristics of spinal cord dorsal horn neurons in chronic allodynic rats after spinal cord injury. J Neurophysiol 2004; 92: 1391–1399.
Widerstrom-Noga EG, Turk DC . Exacerbation of chronic pain following spinal cord injury. J Neurotrauma 2004; 21: 1384–1395.
Acknowledgements
We are grateful for support from the Consejería de Castilla La Mancha (04043-00) and the Fundación Mutua Madrileña. Financial support for JGS was made by the Fundación Hospital Nacional de Parapléjicos para la Investigación y la Integración and the Fundación para la Investigación Sanitaria en Castilla-La Mancha (MOV-2010_JI/008). We acknowledge the collaboration of Mabel Torres-Llacsa of the Unidad de Resonancia Magnética and Ma Angeles Pozuelo Gómez of the Unidad de Psiquiatría y Psicología Clínica, Hospital Nacional de Parapléjicos, SESCAM.
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Gómez-Soriano, J., Goiriena, E., Florensa-Vila, J. et al. Sensory function after cavernous haemangioma: a case report of thermal hypersensitivity at and below an incomplete spinal cord injury. Spinal Cord 50, 711–715 (2012). https://doi.org/10.1038/sc.2012.69
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DOI: https://doi.org/10.1038/sc.2012.69
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