Atraumatic thoracic spinal fracture mimicking herpes zoster neuralgia: a case report

Background Intercostal neuralgia is most common in patients with herpes zoster, but it might be the initial symptom of serious diseases, such as atraumatic spinal fracture, which may lead to serious consequences if not diagnosed and treated early. Severe intercostal neuralgia is rarely reported as the first symptom of ankylosing spondylitis with atraumatic vertebral fractures. Case presentation A 70-year-old Chinese Han man previously diagnosed with ankylosing spondylitis presented to the hospital with intense intercostal pain without trauma. The patient was initially suspected of having herpes zoster neuralgia; however, he subsequently experienced numbness and weakness of both lower limbs as well as constipation. Thoracic vertebral fracture and compression of the spinal cord were detected with magnetic resonance imaging, and he underwent emergency posterior thoracic spinal canal decompression, and intercostal neuralgia was relieved after surgery. Spinal tuberculosis and tumors were later excluded by pathological examination and follow-up results. A 6-month postoperative follow-up showed that the weakness and numbness of the left lower limb had significantly improved, and his urinary function had recovered. Conclusions Patients with ankylosing spondylitis could develop atraumatic spinal fractures. Severe intercostal neuralgia is an early indicator of spinal fractures, and spinal magnetic resonance imaging is crucial for the diagnosis.

Role of magnetic resonance neurography in intercostal neuralgia; diagnostic utility and efficacy

Objective: To evaluate the utility and efficacy of MR neurography (MRN) in the diagnostic work-up for intercostal neuralgia and to assess the treatment course and outcomes in MRN-imaged clinically suspected intercostal neuropathy cases of chronic chest and abdominal wall pain syndromes. Methods: Following a retrospective cross-sectional study, a consecutive series of patients who underwent MRN of torso for suspected intercostal neuralgia were included. Patient demographics, pain location/level/duration, previous work-up for the same indication, MRN imaging results, and MRN cost per patient were recorded. An inter-reader reliability assessment was performed on the MRN findings using Cohen’s weighted κ analysis. Post-MRN treatment choice, as well as success rates of MRN directed perineural injections and surgical management were also evaluated. Results: A total of 28 patients (mean ± SD age, 48.3 ± 18.0 years, female/male = 3.0) were included. Pain and/or numbness in the right upper quadrant were the most common complaints. The mean maximum pain level experienced was 7.4 ± 2.5 on a 1 (lowest pain level) - 10 (highest pain level) visual analog scale. The duration of pain before MRN work-up was 36.9 ± 37.9 months. The patients had seen an average of 5 ± 2.8 physicians for such syndromes. 20 (71%) patients had one or multiple other imaging studies for prior work-up. MRN identified positive intercostal nerve abnormality in 19 cases with clinical symptoms of intercostal neuralgia. From the inter-reader reliability assessment, a Cohen’s weighted κ value of 0.78 was obtained. The costs of work-up was about one-third with MRN for diagnostic purposes with less financial and psychological harm. Among the MRN-positive cases, 9/19 patients received perineural injections, of which 6 reported improvement after their first round, lasting an average of 41.1 ± 83 days. Among the nine MRN-negative cases, two received perineural injections, of which none reported improvement. Surgical management was mostly successful with a positive outcome in six out of seven operated cases (85.7%). Conclusion: MRN is useful in diagnostic algorithm of intercostal neuralgia and MRN-positive cases demonstrate favorable treatment response to perineural injections and subsequent surgical management. Advances in knowledge: The use of MRN in intercostal neuralgia is an application that has not been previously explored in the literature. This study demonstrates that MRN offers superior visualization of pathology in intercostal neuralgia and confirms that treatment directed at MRN identified neuropathy results in good outcomes while maintaining cost efficiency.

Chronic intercostal neuralgia after placement of right ventricle to pulmonary artery conduit with prosthetic valve

Adults with congenital heart disease often have complex medical issues requiring individualised multidisciplinary care for optimising outcomes and quality of life. Chronic pain is an example. We report a rare case of intercostal neuralgia seemingly caused by irritation from a prosthetic valve in a right ventricle to pulmonary artery conduit in a patient with tetralogy of Fallot. Intercostal neuralgia is a painful disorder linked to nerve irritation or injury from trauma, infection or pressure. Although chronic postsurgical pain after cardiac surgery is prevalent, rarely the aetiology relates to valve irritation on a single intercostal nerve. After failing pharmacological therapy for 8 months, the neuralgia completely resolved after an ultrasound-guided neurolytic block with long-term effectiveness and improvement in patient satisfaction.

Intravenous lidocaine and magnesium on responses of A-δ and A-β nerve fibers at non-affected and affected areas in three cases of neuralgias

Intravenous magnesium and lidocaine have been used for the management of intractable pain individually or in combination. A study reported on the positive effects when used in combination on neuralgia when antiepileptic drugs failed, but nobody has clarified how the combination works. The aim of the present case report is to see how a combination of intravenous magnesium and lidocaine influenced electrically-evoked responses of peripheral A-δ and A-β nerve fibers at non-affected and affected areas in three patients with neuralgia. For nociceptive stimulation, a method of intraepidermal electrical stimulation (IES) was used for the selective activation of cutaneous A-δ fibers, using a stainless steel concentric bipolar needle electrode. For tactile stimulation, similar cutaneous sites were stimulated for cutaneous A-β fibers using the same electrode. Three patients with intractable trigeminal neuralgia or intercostal neuralgia were treated using an intravenous infusion of a combination of 1.2g of magnesium and 100mg of lidocaine for one hour. Although all patients experienced sound pain relief after the combined intravenous infusion therapy, the combination had a different effect on electrically-evoked responses of peripheral A-δ and A-β nerve fibers at non-affected and affected areas in each patient.

Toddalia asiatica L. - A Rich Source of Phytoconstituents with Potential Pharmacological Actions, an Appropriate Plant for Recent Global Arena

: Toddalia asiatica L. is used for a long period against various chronic diseases. The main objective of the present review is to search the literature for the folklore uses, phytochemicals isolated and their pharmacological properties of Toddalia asiatica L. The individual plant parts possess many phytoconstituents with therapeutic actions. The root bark of the plant is antimalarial, antipyretic and carminative. Plant leaves and stems have bitter taste and analgesic in nature. Leaf essential oil is used in relieving rheumatic arthritis, sprains, contusions, intercostal neuralgia, cough, malaria, dysentery and gastralgia. This compiled data may be helpful for the researchers to focus on the areas of research yet to be discovered. Complete information about the plant has been collected from various books, journals etc.