Maleki Jahangir, LeBel Alyssa A, Bennett Gary J, Schwartzman Robert J
Department of Neurology, MCP Hahnemann University, Broad & Vine Street (Mail Stop 423), Philadelphia, PA 19102-1192, USA.
Pain. 2000 Dec 1;88(3):259-266. doi: 10.1016/S0304-3959(00)00332-8.
There are reports that complex regional pain syndrome, type I (reflex sympathetic dystrophy; CRPS-I/RSD) can spread from the initial site of presentation, but there are no detailed descriptions of the pattern(s) of such spread. We describe a retrospective analysis of 27 CRPS-I/RSD patients who experienced a significant spread of pain. Three patterns of spread were identified. 'Contiguous spread (CS)' was noted in all 27 cases and was characterized by a gradual and significant enlargement of the area affected initially. 'Independent spread (IS)' was noted in 19 patients (70%) and was characterized by the appearance of CRPS-I in a location that was distant and non-contiguous with the initial site (e.g. CRPS-I/RSD appearing first in a foot, then in a hand). 'Mirror-image spread (MS)' was noted in four patients (15%) and was characterized by the appearance of symptoms on the opposite side in an area that closely matched in size and location the site of initial presentation. Only five patients (19%) suffered from CS alone; 70% also had IS, 11% also had MS, and one patient had all three kinds of spread. Our results suggest that CRPS-I/RSD spread may not be a unitary phenomenon. In some it may be due to a local spread of pathology (CS); in others it may be a consequence of a generalized susceptibility (IS). In the MS case, spread may be due to abnormal neural functioning spreading via commissural pathways. Alternatively, we discuss the possibility that all three kinds of spread may be due to aberrant CNS regulation of neurogenic inflammation.
有报告称，I型复杂性区域疼痛综合征（反射性交感神经营养不良；CRPS-I/RSD）可从最初出现症状的部位扩散，但尚无关于这种扩散模式的详细描述。我们对27例经历了疼痛显著扩散的CRPS-I/RSD患者进行了回顾性分析。确定了三种扩散模式。所有27例患者均出现“连续扩散（CS）”，其特征是最初受影响区域逐渐且显著扩大。19例患者（70%）出现“独立扩散（IS）”，其特征是在与初始部位距离远且不连续的位置出现CRPS-I（例如，CRPS-I/RSD先出现在一只脚，然后出现在一只手）。4例患者（15%）出现“镜像扩散（MS）”，其特征是在与初始表现部位大小和位置紧密匹配的对侧出现症状。仅5例患者（19%）仅患有CS；70%的患者还患有IS，11%的患者还患有MS，1例患者三种扩散类型均有。我们的结果表明，CRPS-I/RSD的扩散可能不是单一现象。在某些情况下，可能是由于病理的局部扩散（CS）；在其他情况下，可能是全身易感性的结果（IS）。在MS病例中，扩散可能是由于异常神经功能通过连合通路传播。或者，我们讨论了所有三种扩散类型可能都是由于中枢神经系统对神经源性炎症的异常调节的可能性。
