Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Taegu, Republic of Korea.
Department of Physical Medicine and Rehabilitation, Centre hospitalier de l'Université de Montréal, 3840, Saint-Urbain St., Montreal, QC, H2W 1T8, Canada.
BMC Neurol. 2020 Feb 18;20(1):61. doi: 10.1186/s12883-020-01644-0.
We report a patient with unusual occipital neuropathic pain (at-level neuropathic pain) due to a small central cervical spinal cord injury (SCI).
A 50-year-old man presented with severe bilateral occipital pain after falling from a height of 2 m, 2 weeks ago. The degree of pain was evaluated to be 9 out of 10 using the numeric rating scale (NRS). The nature of the pain was tingling, burning, and piercing, and hyperalgesia was present over the bilateral posterior head regions. Greater occipital nerve block with bupivacaine and dexamethasone was not effective. On axial T2-cervical magnetic resonance imaging (MRI), a focal high signal change was observed in the central portion of the spinal cord at the C2 level. We deliberated that the patient's pain was due to the SCI observed on MRI, and after administration of oral medications, the NRS pain score reduced from 9 to 2.
Neuropathic pain caused by SCI varies according to the location and degree of injury of the pain-related neural tracts; therefore, clinicians should closely observe the pain patterns and findings on imaging in patients with SCI to determine the cause of pain accurately.
我们报告了一例由于小的中央颈脊髓损伤（SCI）导致的不常见的枕部神经性疼痛（同水平神经性疼痛）的患者。
一名 50 岁男性，2 周前从 2 米高处坠落，出现严重双侧枕部疼痛。疼痛程度用数字评分量表（NRS）评估为 9 分（满分 10 分）。疼痛性质为刺痛、烧灼感和刺痛感，双侧后头部存在痛觉过敏。布比卡因和地塞米松的枕大神经阻滞无效。颈椎轴位 T2 磁共振成像（MRI）显示 C2 水平脊髓中央部分有局灶性高信号改变。我们认为患者的疼痛是由 MRI 观察到的 SCI 引起的，口服药物治疗后，NRS 疼痛评分从 9 分降至 2 分。
SCI 引起的神经性疼痛根据与疼痛相关的神经束的损伤位置和程度而不同；因此，临床医生应密切观察 SCI 患者的疼痛模式和影像学发现，以准确确定疼痛的原因。
