• The Korean Journal of Pain
• /
• v.23 no.3
• /
• pp.211-214
• /
• 2010

Spontaneous retropharyngeal hematoma is rare and difficult to diagnosis early. A 23-year-old male spontaneously developed acute onset of neck pain, limitation of neck motion, and mild dysphagia. Magnetic resonance imaging demonstrated blood products in prevertebral space from C2 to C4, suggesting a diagnosis of retropharyngeal hematoma. We report a rare case of spontaneous retropharyngeal hematoma causing neck pain.

• Imaging Science in Dentistry
• /
• v.44 no.4
• /
• pp.293-299
• /
• 2014

Purpose: This study was performed to find the relationship between pain and joint effusion using magnetic resonance imaging (MRI) in temporomandibular disorder (TMD) patients. Materials and Methods: The study subjects included 232 TMD patients. The inclusion criteria in this study were the presence of spontaneous pain or provoked pain on one or both temporomandibular joints (TMJs). The provoked pain was divided into three groups: pain on palpation (G1), pain on mouth opening (G2), and pain on mastication (G3). MRI examinations were performed using a 1.5-T MRI scanner. T1- and T2-weighted images with para-sagittal and para-coronal images were obtained. According to the T2-weighted image findings, the cases of effusions were divided into four groups: normal, mild (E1), moderate (E2), and marked effusion (E3). A statistical analysis was carried out using the $X^2$ test with SPSS (version 12.0, SPSS Inc., Chicago, IL, USA). Results: Spontaneous pain, provoked pain, and both spontaneous and provoked pain were significantly related to joint effusion in TMD patients (p<0.05). However, among the various types of provoked pain, pain on palpation of the masticatory muscles and TMJ (G1) was not related to joint effusion in TMD patients (p>0.05). Conclusion: Spontaneous pain was related to the MRI findings of joint effusion; however, among the various types of provoked pain, pain on palpation of the masticatory muscles and TMJ was not related to the MRI findings of joint effusion. These results suggest that joint effusion has a significant influence on the prediction of TMJ pain.

• The Korean Journal of Pain
• /
• v.18 no.1
• /
• pp.60-63
• /
• 2005

This report describes the successful treatment of spontaneous intracranial hypotension (SIH) with multiple cerebrospinal fluid (CSF) leaks using 10 applications of epidural blood patches (EBP). A forty year old female who suffered with a postural headache was diagnosed as having SIH. On the cisternography, multiple CSF leaks were noted at the thoracic and lumbar area. Her headache was not improved with conservative treatments such as bed rest, hydration and NSAIDS. So, she underwent treatment with EBPs. After 10 applications of site-directed EBPs, her headache was resolved gradually and completely without any complications.

• The Korean Journal of Pain
• /
• v.23 no.1
• /
• pp.46-50
• /
• 2010

Spontaneous intracranial hypotension (SIH) is considered to be a very rare disorder. It is characterized by an orthostatic headache that is aggravated with the patient in the upright position and it is relieved by the patient assuming the supine position. SIH is caused by a spontaneous spinal cerebrospinal fluid leakage without the patient having undergone trauma, surgery or dural puncture or having any other significant medical history. An autologous epidural blood patch (EBP) is effective in relieving SIH. We report here on a case of SIH with cerebrospinal fluid leakage at the upper cervical vertebral level and the middle thoracic vertebral level. The points of leakage were identified by radionuclide cisternography, and this patient was successfully managed by injecting an EBP at each level of leakage.

• The Korean Journal of Pain
• /
• v.12 no.1
• /
• pp.157-161
• /
• 1999

We report a patient with spontaneous intracranial hypotension. In addition to the cardinal feature of a postural headache and a low CSF pressure, the patient also had subdural hematoma demonstrated by brain MRI. Radionuclide cisternography revealed a CSF leakage in the intracranium. CSF leakage from spinal meningeal defects may be the most common cause of this syndrome. The headache is a consequence of the low CSF pressure producing displacement of pain-sensitive structures. Methods of treatment are identical to those for post-dural puncture headaches. We experienced a patient with spontaneous intracranial hypotension developed in the intracranium who was successfully managed with a cervical blood patch.

• The Korean Journal of Pain
• /
• v.20 no.2
• /
• pp.235-239
• /
• 2007

Spontaneous intracranial hypotension (SIH) is believed to be a benign disease. However, numerous studies have reported serious complications related to SIH, including subdural hematoma. In this case report, a 54-year-old male patient visited the emergency room with orthostatic headache. A brain magnetic resonance imaging (MRI) study showed diffuse mild thickening and enhancement of pachymeninges, with a suspicious minimal amount of subdural fluid collected in the left posterior parietal area. His orthostatic headache showed no improvement with conservative treatment; but his pain was almost completely relieved after two trials of cervical epidural blood patch. On the 74th day after the onset of his pain, the patient showed a drowsy mental status and slurred speech when he visited the pain clinic. Brain computerized tomography indicated a left subdural hemorrhage, and he underwent emergency operation to drain the SDH. In conclusion, pain clinicians should pay attention to abrupt changes in mental status as well as continuous headache, for the early diagnosis of SDH in SIH patients.

• The Korean Journal of Pain
• /
• v.21 no.1
• /
• pp.84-88
• /
• 2008

The spontaneous regression of herniated cervical discs is not a well established phenomenon. However, we encountered the 3 cases of spontaneous regression of severe radiculopathic herniated cervical discs that were treated using a non-surgical method. Each of the patients were treated with a combination of manipulation, dry needling and analgesics. In each case, the symptoms improved within 12 months of treatment and magnetic resonance imaging (MRI) conducted at that time revealed marked regression of the herniated disc in all cases. These cases provide additional examples of spontaneous regression of herniated cervical discs documented by MRI following non-surgical treatment.

• The Journal of Korean Physical Therapy
• /
• v.22 no.3
• /
• pp.17-21
• /
• 2010

Purpose: This study was designed to investigate possibilities for quantitative analysis using the electromyography and sonography. For better understanding, we evaluated the correlation between the pressure pain threshold and sonography, spontaneous electrical activity in trigger points located in the upper trapezius muscle. Methods: Thirty three active subjects volunteered to participate in this study (n=33). They had a palpable taut band, exquisite spot tenderness of a nodule in a taut band, spontaneous pain, referred pain, jump sign, local twitch response, and a painful limit to full stretch range of motion. We measured Pressure pain threshold, density, white area index, root mean square, and reaction. Pearson’s correlation coefficient was calculated to estimate the relationship between the pressure pain threshold and other variables including density, white area index, root mean square, and reaction time. Results: There were significant correlations between pressure pain threshold and density (r=-0.75, p<0.01), and between pressure pain threshold and white area index (r=-0.74, p<0.01). A significant correlations between pressure pain threshold and root mean square (r=-0.59, p<0.01). The significant correlation was found between pressure pain threshold and reaction time (r=-0.64, p<0.01). Conclusion: These should indicate whether quantitative analysis can be done using the characteristics of electromyography and sonography.

• The Korean Journal of Pain
• /
• v.25 no.2
• /
• pp.112-115
• /
• 2012

Intracranial hypotension is characterized by a postural headache which is relieved in a supine position and worsened in a sitting or standing position. Although less commonly reported than postural headache, sixth nerve palsy has also been observed in intracranial hypotension. The epidural blood patch (EBP) has been performed for postdural puncture headache, but little is known about the proper timing of EBP in the treatment of sixth nerve palsy due to intracranial hypotension. This article reports a case of sixth nerve palsy due to spontaneous intracranial hypotension which was treated by EBP 10 days after the onset of palsy.

• The Korean Journal of Pain
• /
• v.13 no.1
• /
• pp.79-83
• /
• 2000

Background: Spontaneous intracranial hypotension is a syndrome characterized by postural headache without trauma, spinal anesthesia or other medical history. The purpose of this study is to analyze the effect of epidural blood patch in spontaneous intracranial hypotension. Methods: The spontaneous intracranial hypotension patients treated with epidural blood patch were analyzed on the symptoms, radiologic images and methods of epidural blood patch retrospectively by the medical records. Results: Patients had postural headache (15 patients) including nausea/vomiting (10 patients), tinnitus (2 patients), neck stiffness (13 patients), vertigo (3 patients) and occular pain (1 patient). Brain CT and MRI showed diffuse enhancement of the pachymeninges (9 patients) and radionuclide cisternography demonstrated direct evidence of leakage (11 patients). With epidural blood patch, the symptoms were promptly relieved in 11 patients. Conclusions: We concluded that epidural blood patch is a good treatment of method in spontaneous intracranial hypotension patients.