To establish the prognostic value of different electrophysiological examinations, we investigated their efficacy in patients with facial palsy for up to 6 months.
One hundred patients with peripheral facial palsy were investigated. Electrophysiological tests were: electroneuronography (ENoG), electrogustometry, stapedial reflex (SR) and blink reflex (BR). Tests were performed at the first visit of outpatients with facial palsy. The palsy scale with the full score of 40 points was examined every 2 weeks during the 6 months, and we defined a scale of 36 points or more as indicating that patients were cured. For the first stage, the patients were classified retrospectively into 2 groups: a cured group (n=94) cured within 6 months, and an uncured group (n=6) that scored fewer than 36 points in the 6 months. For the second stage, the cured group was further classified into 2 groups: group A (n=36) cured within one month, and group B (n=58) cured within 1 to 6 months. A multivariate method was employed for statistical analysis.
The first an alysis revealed that ENoG and SR were significantly more indicative than other factors of a good prognosis. From the second analysis, it was found that there was a significant difference between groups A and B in the positive BR ratio.
The present study suggested that ENoG and SR are more useful parameters than other neurophysiological examinations for evaluating the prognosis of facial palsy. In addition, BR is an effective parameter to estimate the probability of easily curing facial palsy.

View full abstract

In the very acute phase of Bell's palsy and Ramsay Hunt syndrome, the increased amplitudes of electroneuronography (ENoG) on the affected side are rarely observed on the intact side. The normal range of amplitude ratios in ENoG was obtained by testing 10 healthy volunteers and the results showed that the upper limit of the normal range was 129%. For the present study, ENoG was conducted on 42 patients with facial palsy who sought medical attention within 4 days of developing symptoms. In ten (24%) of these patients, the amplitude of ENoG exceeded 129% on the affected side (an abnormally large amplitude) within 4 days of developing symptoms. There was no VII nerve denervation in any patients with abnormally large amplitudes on ENoG, and their prognosis was found to be good. Thus, abnormally large amplitudes on ENoG indicated a favorable prognosis for facial palsy. The results suggest that abnormally large amplitudes on ENoG may predict the prognosis of facial palsy in the early stage of the disease.

View full abstract

A 47-year-old woman who had been suffering from severe right orbital and temporo-occipital headache since she was 20-year-old was admitted. The headache was associated with right conjunctival hyperemia, lacrimation, nasal congestion, and vomiting. Although the patient had been given ergotamine tartrate and received stellate ganglion block (SGB) and trigger point block, these were ineffective. Because she had tender points at the temporal and occipitoatlantar regions, she was treated with auriculotemporal nerve block and occipitoatlantal joint block at the same time. The headache disappeared immediately after these treatment. Although mild headache recurred five days after, it was successfully treated with ergotamine tartrate and SGB. After that, her severe headache disappeared.

View full abstract

Two patients with severe low back pain were finally diagnosed as multiple spinal metastasis of malignant tumors. They were revealed to have no malignancy by close examinations in an other hospital. So we started pain treatment without further examinations. But the epidural block was not as effective as usual and the pain was intensifying. As we suspected the presence of malignancy, close examinations were scheduled. However, their general conditions worsened suddenly, and they died a few weeks later after emergency admission. The spinal lesion was metastasis of lung cancer in both cases.

View full abstract

We report a case of spontaneous intracranial hypotension (SIH) treated with a cervical epidural blood patch (EBP). The patient was a 42-year-old woman with severe headache. Myelography CT detected cerebrospinal fluid (CSF) leak at the high cervical region (C2-C3). She was point out subdural hematoma and subdural edema with MRI. Initial treatment was centered on conservative therapy of bed rest and intravenous drip infusion. But the headache showed no sign of receding and in crease of subdural hematoma was concerned. Thus, we decided to simultaneously perform cervical EBP and operation of the subdural hematoma. We performed EBP with 7ml of autologous blood at the C7-Th1 interspace. The patient's headache disappeared immediately after EBP. SIH is an uncommon disease caused by CSF leakage. It is often self-limiting, responding to bed rest and/or intravenous drip infusion. However, if the symptoms of SIH are not dramatically reduced by conservative therapies, EBP has been reportedly used for the management of these cases. The reason EBP is considered to be effective is because it causes a increase in the pressure and volume of cerebrospinal fluid and autologous blood patches up the fluid leakage. We believe EBP should be performed for SIH, and that EBP using small amounts of autologous blood is an effective treatment

View full abstract

An 83-year-old man, suffering from lumbago and leg pain due to lumbar disc hernia and spinal canal stenosis, had received epidural block with steroid treatment once a month. After the ninth epidural block, he complained of increased leg pain and right iliopsoas and epidural abscesses were revealed by magnetic resonance imaging. Puncture of the iliopsoas abscess under computed tomographic guidance was conducted and antibiotics were also administered about for 30 days thereafter. After the therapy, his leg pain was alleviated remarkably as the abscesses of the iliopsoas muscle and epidural space had almost vanished. Inflammatory changes, however, were prolonged. He was discharged without any neurological sequelae after 33 days of hospitalization.

View full abstract

A 34-year-old male presented CRPS (complex regional pain syndrome) type I of the right lower limb after a right knee operation. Initially, the pain considerably improved after continuous lumbar epidural block and lumbar sympathetic nerve block and drug therapy. But two months later, CRPS recurred. Because it seemed that the symptoms included a psychological factor, treatment was planned with psychiatric intervention. After successful psychiatric medication, his left hand represented phlegmonous change in association with purulent tendovaginitis. After incision drainage, extreme pain was experienced in the left upper limb, which showed resistance against various treatments, also diagnosed as multi-site CRPS type I. Because the patient showed a concomitant psychological symptom, we applied electroconvulsive therapy, which successfully reduced the pain and improved the activities of daily living.

View full abstract