Dan Hiroyuki, Kim Kyongsong, Ishiwada Tadahiro, Aoyagi Masaru, Murai Yasuo
Department of Neurological Surgery, Shioda Memorial Hospital, Chiba, JPN.
Department of Neurological Surgery, Chiba Hokusoh Hospital, Chiba, JPN.
Cureus. 2024 Aug 29;16(8):e68114. doi: 10.7759/cureus.68114. eCollection 2024 Aug.
Lower back and lower limb pain can hamper the rehabilitation of cerebral stroke patients. We report that peripheral nerve blocks enabled two patients to continue rehabilitation. Case 1 was an 83-year-old female with left hemiparesis due to cerebral infarction of the right basal ganglia. Rehabilitation started on the day after the stroke onset. On the 7 post-stroke day, she reported right buttock and dorsal thigh pain. Lumbar MRI demonstrated no lumbar spinal canal stenosis and no nerve impingement. The middle cluneal nerve block alleviated her buttock pain. On the 29 post-stroke day, she suffered severe pain on the medial side of the right knee. Blocking the infrapatellar branch of the saphenous nerve lessened that pain, she was able to walk without assistance, and rehabilitation was resumed. Case 2 was an 87-year-old female with sudden-onset left hemiparesis due to cardiogenic cerebral infarction. Intravenous thrombolysis and mechanical thrombectomy were performed. She presented with left hemiparesis due to infarcts at the right basal ganglia and the right temporal and parietal lobes. Her chronic low back pain worsened after admission and walking was difficult. Bilateral superior and middle cluneal nerve blocks improved her right lower back pain. Left low back pain was alleviated by sacroiliac joint blockage and rehabilitation was possible due to the absence of back pain. The strain on the lower back and lower limbs attributable to paresis due to stroke may lead to entrapment neuropathy. Peripheral nerve blockage is relatively simple and safe and may be useful in acute stroke patients whose rehabilitation is difficult due to pain.
腰背部和下肢疼痛会妨碍脑卒中患者的康复。我们报告了两例患者通过周围神经阻滞得以继续康复的情况。病例1是一名83岁女性，因右侧基底节脑梗死导致左侧偏瘫。卒中发作次日开始康复治疗。卒中后第7天，她报告右臀部和大腿背侧疼痛。腰椎MRI显示无腰椎管狭窄和神经受压。臀中皮神经阻滞缓解了她的臀部疼痛。卒中后第29天，她右膝内侧剧痛。隐神经髌下支阻滞减轻了疼痛，她能够独立行走，并恢复了康复治疗。病例2是一名87岁女性，因心源性脑梗死突然出现左侧偏瘫。进行了静脉溶栓和机械取栓治疗。她因右侧基底节、右侧颞叶和顶叶梗死而出现左侧偏瘫。入院后她的慢性腰背痛加重，行走困难。双侧臀上和臀中皮神经阻滞改善了她的右腰背痛。骶髂关节阻滞缓解了左腰背痛，由于无背痛，康复治疗得以进行。卒中所致轻瘫引起的腰背部和下肢劳损可能导致卡压性神经病。周围神经阻滞相对简单且安全，可能对因疼痛而难以康复的急性卒中患者有用。
