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Pain in wallenberg's lateral medullary syndrome
S85 PAIN
IN WALLENBERG’S
Dr. D. Medical A 52
Moffie Center
year
old
LATERAL
and Dr. H.L. Siotervaart, man was
MEDULLARY SYNDROME. [%FJ
Hamburger, 1066 EC Amsterdam.
hospitalised
on May 24,
1971
with
a diagnosis
of
Wallenberg’s syndrome due to a lesion of the right side of the medulla oblongata. Some months after his discharge from the hospital he began to complain about pain in the left side of his body, including the left side of his neck and his left outer ear, but not in his face on that side. This pain became so severe that the original correct diagnosis of WalTenberg’s syndrome was replaced by the diagnosis of thalamic syndrome.He became depressed, his general condition worsened and a rightsided ieucoAfter that he didn’t complain about tomy was performed in November 1974. pain spontaneously anymore. Later he got epileptic fits and he died of an acute myocardial infarction in december 1976. Autopsy of the brain revealed a cavity on the right side of the medulla oblongata with sparing of the descending spinal trigeminal tract and its in this cavity aberrant nerve fibres were noticed, which seemed nucleus. to penetrate into this cavity along bloodvessels from the surface of the medulla oblongata. This aberrant nerve fibres had the appearance of a periferal neuroma. The cause of this thalamic-like pain is not known and some authors think that it is due to lesions of the non-myelinated thin fibres in the lateral part of the reticular substance, adjoining the spinothalamic tract. It might also be possible that the neuroma-like aberrant nervefibres are the cause of this pain, in analogy to a periphera
1
neuroma.
The literature aberrant fibres
and the ideas are discussed.
about
an
eventual
function
about
these
PHANTOM $JMB PHENOMENA2IN AMPUTEES 7 YEARS AFTE; AMPUTATION. B.Krebs , T.S.Jensen , K.Kroner 1, J.Nielsen and H.~.J~r~ gensen 1, Departments of 1 Orthopedic Surgery and * Neurology,Aarhus University Hospital, Aarhus, Denmark. Aim of investigation: Phantom limb, phantom pain and stump pain are frequently encountered among amputees immediately after limb amputation. The temporal course of these phenomena, however, are not settled. In a retrospective study we have investigated the incidence and clinical picture of phantom limb phenomena as observed approximately 7 years after amputation. Methods: Among 624 consecutive limb amputations performed at two orthopedic departments during the period 1970-1977 95 patients were alive in 1983. 86 patients were able to answer a standard questionaire regarding phantom limb, phantom pain and stump pain. Results: The median age of the group at the time of amputation was 53.6 years, range: 8.9 - 77.5 years, and the median follow-up period was 7.3 years, range: 5.4 - 13.3 years. The main causes of amputation (all lower limb) were peripheral occlusive arterial disease (70%) and trauma (23%). The incidence of phantom limb, phantom pain and stump pain 7 years after amputation was 75%, 54% and 24%, respectively. Phantom limb included kinaesthetic sensations in 55% and in 30% of these the limb was felt to be shortened. Phantom limb and phantom pain were usually present in the distal parts of the limb only. Phantom pain was not more frequent in patients with stump pain than in those without stump pain. Conclusions: The present incidence of phantom limb phenomena in amputees 7 years after amputation is close to the reported incidence 6 months after amputation. Persistent phantom pain may be a more common event than the usual reported frequency of 5-108.
IN WALLENBERG’S
Dr. D. Medical A 52
Moffie Center
year
old
LATERAL
and Dr. H.L. Siotervaart, man was
MEDULLARY SYNDROME. [%FJ
Hamburger, 1066 EC Amsterdam.
hospitalised
on May 24,
1971
with
a diagnosis
of
Wallenberg’s syndrome due to a lesion of the right side of the medulla oblongata. Some months after his discharge from the hospital he began to complain about pain in the left side of his body, including the left side of his neck and his left outer ear, but not in his face on that side. This pain became so severe that the original correct diagnosis of WalTenberg’s syndrome was replaced by the diagnosis of thalamic syndrome.He became depressed, his general condition worsened and a rightsided ieucoAfter that he didn’t complain about tomy was performed in November 1974. pain spontaneously anymore. Later he got epileptic fits and he died of an acute myocardial infarction in december 1976. Autopsy of the brain revealed a cavity on the right side of the medulla oblongata with sparing of the descending spinal trigeminal tract and its in this cavity aberrant nerve fibres were noticed, which seemed nucleus. to penetrate into this cavity along bloodvessels from the surface of the medulla oblongata. This aberrant nerve fibres had the appearance of a periferal neuroma. The cause of this thalamic-like pain is not known and some authors think that it is due to lesions of the non-myelinated thin fibres in the lateral part of the reticular substance, adjoining the spinothalamic tract. It might also be possible that the neuroma-like aberrant nervefibres are the cause of this pain, in analogy to a periphera
1
neuroma.
The literature aberrant fibres
and the ideas are discussed.
about
an
eventual
function
about
these
PHANTOM $JMB PHENOMENA2IN AMPUTEES 7 YEARS AFTE; AMPUTATION. B.Krebs , T.S.Jensen , K.Kroner 1, J.Nielsen and H.~.J~r~ gensen 1, Departments of 1 Orthopedic Surgery and * Neurology,Aarhus University Hospital, Aarhus, Denmark. Aim of investigation: Phantom limb, phantom pain and stump pain are frequently encountered among amputees immediately after limb amputation. The temporal course of these phenomena, however, are not settled. In a retrospective study we have investigated the incidence and clinical picture of phantom limb phenomena as observed approximately 7 years after amputation. Methods: Among 624 consecutive limb amputations performed at two orthopedic departments during the period 1970-1977 95 patients were alive in 1983. 86 patients were able to answer a standard questionaire regarding phantom limb, phantom pain and stump pain. Results: The median age of the group at the time of amputation was 53.6 years, range: 8.9 - 77.5 years, and the median follow-up period was 7.3 years, range: 5.4 - 13.3 years. The main causes of amputation (all lower limb) were peripheral occlusive arterial disease (70%) and trauma (23%). The incidence of phantom limb, phantom pain and stump pain 7 years after amputation was 75%, 54% and 24%, respectively. Phantom limb included kinaesthetic sensations in 55% and in 30% of these the limb was felt to be shortened. Phantom limb and phantom pain were usually present in the distal parts of the limb only. Phantom pain was not more frequent in patients with stump pain than in those without stump pain. Conclusions: The present incidence of phantom limb phenomena in amputees 7 years after amputation is close to the reported incidence 6 months after amputation. Persistent phantom pain may be a more common event than the usual reported frequency of 5-108.