Background: Primary erythromelalgia (PE) is a rare disorder characterized by thermalgia. It is caused by mutations in voltage-gated Na channel (Nav) 1.7, which increase neuron excitability. The symptom of salt aversion in PE has not yet been reported. Case presentation: A 72-year-old woman had experienced severe frostbite since childhood. The patient developed redness as she warmed up at the age of 40 years and thermalgia as well as a salt aversion due to hypersensitivity to saltiness at the age of 70 years. She was diagnosed with PE. At the age of 72 years, we initiated treatment with stellate ganglion blocks (SGB) and epidural blocks. The symptom of salt aversion and pain in fingertips disappeared after treatment with SGB. Bilateral lumbar sympathetic ganglion blocks were performed to further attenuate pain in the tips of the toes, which disappeared after 2 months. Conclusions: We herein report the successful treatment of PE with hypersensitivity to saltiness.

Xenon light (Xe) is one of the photobiomodulation therapy frequently used for treating pain. It is easy to use because it has few side effects and the procedure is simple. Xe can simultaneously treat both superficial and deep layers of the body due to its multiple wavelengths with different absorbances, and alleviate pain through effects such as vasodilation, promotion of tissue repair, neuroprotection, anti-inflammatory action, and inhibition of nerve transmission. We report a case in which photobiomodulation therapy with Xe was effective in relieving acute intractable pain in the femoral nerve region related to insertion of a femoral cannulation for robotic heart surgery.

A 90-year-old man presented with sudden onset of superior visual field loss in the right eye after taking a bath at night. On the next day, he consulted an ophthalmologist. He was diagnosed with branch retinal artery occlusion (BRAO). When he was referred to our hospital 17 hours after onset, he complained of nearly complete vision loss in the right eye. A stellate ganglion block (SGB) with 1％ lidocaine was performed immediately. His visual deficit resolved dramatically soon after. BRAO is an emergent condition that requires rapid diagnosis and treatment. BRAO is caused by an embolism from the carotid artery, heart, or aortic arch, which leads to occlusion of the branch retinal artery. SGB increases retinal blood velocity and might have a beneficial effect of washing out the embolus. Aggressive treatment with SGB is important for improving the prognosis for vision.

A 42-year-old male with idiopathic thrombocytopenic purpura (ITP) had been consulted a neurosurgeon for an orthostatic headache and had undergone a drainage against chronic subdural hematoma. Idiopathic cerebro-spinal fluid leak was suspected, however, there were some possibilities of due to minor trauma. Although a CT myelography was needed to make a definitive diagnosis, we diagnosed with cerebro-spinal fluid leak by MR myelography to avoid intraspinal bleeding. At the same time, we consulted the hematologist and started the platelet recovery therapy. After injecting autologous blood and iohexol, we examined the spread of injected blood using intraoperative cone-beam CT to determine whether additional epidural blood patch (EBP) would be required. No additional EBP was needed. Consequently, he made a full recovery without any complications. A case of cerebrospinal fluid leakage associated with idiopathic thrombocytopenic purpura was a high-risk patient, but fortunately was treated without complications. Intraoperative cone-beam CT is useful for examining the spread of injected blood.

Percutaneous epidural adhesiolysis (PEA) is performed to manage low back pain and leg pain due to degenerative lumbar disease including failed back surgery syndrome (FBSS). There are no detailed reports on its effectiveness in patients with axial low back pain lacking leg pain. We present a case of chronic axial low back pain that was completely cured by PEA using a spring-guide catheter. A 28-year-old Japanese man had a history of three-times surgery for L4/5 lumbar disc herniation, and although the pain in his lower extremities disappeared, the left low back pain did not improve and persisted for a long time. Transforaminal epidurography indicated adhesion of the left ventral epidural space at the lower border of the L4 vertebral body, then PEA with spring-guide catheter methods markedly relieved the pain immediately after the procedure without any recurrence. PEA following concurrent epidurography may be an effective treatment even for FBSS causing axial low back pain without leg pain.