Central pain syndrome : pathophysiology, diagnosis, and by Sergio Canavero MD, Vincenzo Bonicalzi MD

By Sergio Canavero MD, Vincenzo Bonicalzi MD

Crucial ache Syndrome is a neurological situation attributable to harm in particular to the crucial anxious approach - mind, brainstem, or spinal wire. this is often the single up to date ebook on hand at the scientific elements (including prognosis and treatment) of CPS administration. The authors have built a really entire reference resource on vital ache, together with historical past fabric, pathophysiology, and diagnostic and healing info. A scientific secret for a hundred years with out potent treatment, this publication turns the concept that of incurability of important ache on its head, delivering a rational method of remedy in response to a rational concept.

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Example text

Tactile allodynia. Lesion described as ischemic in Table 1, but as hematoma in text 11 R L Face, hand, stump N (Lo) N R frontal-rolandic (postcentral gyrus) hematoma Previous (3 years) L leg amputation (ischemic disease). Phantom limb without phantom pain. Patchy pain. No allodynia. Warm hypoesthesia over the L hand, with cold and pinprick sensibility spared. Epileptic painful fits (showing a jacksonian march from hand to face and involving the phantom foot), phenytoin-responsive (disappearance of fits and pain).

CP and dissociated loss of thermoalgesic sensations in 5 patients. MRI confirmed lesion; extension determined on published atlases. (1) CP with dissociated loss of thermoalgesic sensations: 5 patients (insula/operculum ischemic stroke in all). R-sided 3, L-sided 2 cases (data disagreement between text, tables, and figures in the original paper). Lesion site: (1) L posterior insula + innermost parietal operculum; (2) L (R in Table 2 and Fig. 1) posterior insula + medial operculum; (3) R (Tables 1 & 2 and Fig 1; L in text) posterior and mid-insula (4/5th; 3/4th in text) + antero-inferior parietal operculum; (4) R insula (2/3rd) + lower parietal lobe (subcortical extension to the IC); (5) R posterior insula + medial and lateral operculum (2) CP with lemniscal and pain/temperature deficit: 13 patients (cortical stroke, ischemic in 6 cases, hemorrhagic in 6 cases, post-surgical in 1 case).

Worldwide, c. 300 000–400 000 MS patients may suffer CP. It has been estimated that 2–4% of cancer patients suffer CP from both primary and metastatic tumors. CP is more prevalent in patients with spinal cord rather than brain masses (Gonzales et al. 2003; see also Beatty 1970). In 2002, of the 11 million new cancer cases estimated worldwide, c. 45% were in Asia, 26% in Europe, and c. 15% in the USA. Metastatic tumors are the most common CNS neoplasms: the true incidence is probably underestimated but the literature reports up to 11/100 000 per year.

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