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H7N9 avian influenza with first manifestation of occipital neuralgia:A case report

World Journal of Clinical Cases 2023年第2期11卷 434-440页

作者： Jie Zhang Department of Neurology Neuromedical CenterAviation General HospitalBeijing 100012China

BACKGROUND Most of the first symptoms of avian influenza are respiratory symptoms,and cases with occipital neuralgia as the first manifestation are rarely *** SUMMARY A middle-aged patient complaining of paroxysmal pain behind the ear was admitted to our *** patient’s condition changed rapidly,and high fever,unexpected respiratory failure,and multiple organ failure developed *** patient was diagnosed with H7N9 avian influenza based on *** We believe that the etiology of occipital neuralgia is complex and could be the earliest manifestation of severe *** possibility of an infectious disease should be considered when occipital neuralgia is accompanied by *** influenza is one of these causative agents.

关键词： occipital neuralgia Avian influenza Respiratory Infectious Case report

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OnabotulinumtoxinA Nerve Blocks in the Treatment of occipital neuralgia

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Pain Studies and Treatment 2016年第3期4卷 29-34页

作者： Andrew Ea Terence Gray University of New England College of Osteopathic Medicine Biddeford ME USA Mercy Hospital Interventional Pain Center Portland ME USA

occipital neuralgia is characterized by severe pain, accompanied by tenderness and trigger points, in the distribution of the greater, lesser, and/or third occipital nerves. occipital neuralgia is typically idiopathic, but also is characterized as a common form of posttraumatic headache. Typical treatments include nerve blocks with local anesthetic, nerve stimulation, pulsed radiofrequency, and cryoablation. OnabotulinumtoxinA (ONA) has recently been utilized in nerve blocks to treat occipital neuralgia, with the potential for a longer duration of pain relief than local anesthetic. Our study retrospectively examined 63 patients treated for occipital neuralgia, including 19 with ONA. 80 - 155 units of ONA were administered bilaterally in the surrounding musculature. A total of 61 patients, including 17 of those subsequently treated with ONA, were treated with local anesthetic, using a 1:1 mixture of 0.25% bupivacaine and 1% lidocaine, plus triamcinolone. Patients reported VAS pain scores before and after their procedures, and again during 4-week follow-up visits. Information on opioid use, overall pain relief, and duration of full relief was also recorded upon follow-up. Patients treated with ONA exhibited significant decreases in average VAS pain scores from 4.1 ± 2.6 pre-procedure to 2.1 ± 2.4 post-procedure (p = 2 × 10 -5), and 3.0 ± 2.5 4 weeks later (p = 0.0234). Mean overall relief was 75.8% ± 25.0%. Treatment with local anesthetic suggested equally efficacious reduction of VAS scores;however, treatment with ONA showed a significantly higher percentage of overall pain relief leading to follow-up. Opioid use did not exhibit significant change, regardless of treatment type. Our results support the hypothesis that use of Onabotulinum-toxinA in occipital nerve blocks leads to significant decreases in pain, while possibly exhibiting a longer duration of action than that of local anesthetic.

关键词： occipital neuralgia OnabotulinumtoxinA Botox Bupivacaine Lidocaine

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OnabotulinumtoxinA in the Treatment of occipital neuralgia Following Gunshot Injury

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Pain Studies and Treatment 2016年第4期4卷 43-47页

作者： Andrew Ea Terence Gray University of New England College of Osteopathic Medicine Biddeford USA Mercy Hospital Interventional Pain Center Portland USA

occipital neuralgia, while typically idiopathic in presentation, is a common form of posttraumatic headache. It is associated with severe pain in the greater, lesser, and/or third occipital nerves, and often accompanied by tenderness or trigger points in the surrounding musculature. OnabotulinumtoxinA (ONA) has been recently utilized in nerve blocks to treat occipital neuralgia, but current literature supporting such use is scarce. We describe a case of occipital neuralgia in a patient following C1 fracture and vertebral artery dissection due to gunshot injury. Successful treatment with bilateral ONA nerve blocks led to an 80% - 90% improvement in pain, with decreased Visual Analog Scale (VAS) pain scores immediately following treatment and upon follow-up 1 month later.

关键词： occipital neuralgia OnabotulinumtoxinA Botox Bupivacaine Lidocaine Gunshot

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Repeat RF Ablation of C2 and Third occipital Nerves for Recurrent occipital neuralgia and Cervicogenic Headaches

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World Journal of Neuroscience 2016年第4期6卷 236-242页

作者： John F. Hamer Traci A. Purath Oak Brook IL USA Purath Headache and Neurology Greenfield WI USA

Objective: To address the degree and duration of pain relief from recurrent cervicogenic headaches and/or occipital neuralgia following retreatment with radiofrequency ablation of the C2 dorsal root ganglion and/or third occipital nerves;to review outcomes including duration and degree of pain relief;to evaluate procedure’s complication rate and patient’s willingness to repeat the procedure;to compare effectiveness of the most recent RF ablation to patient’s first RF ablation. Methods: This is a single-center retrospective observational study of 23 patients with recurrent cervicogenic headaches and/or occipital neuralgia treated with repeated RF ablation of the C2 dorsal root ganglion and/or third occipital nerves. All patients receiving treatment from January 2010 to July 2014 are included in this single site retrospective study. This is an IRB approved medical chart review study. Results: 22 of 23 patients underwent follow-up. An average of 86.5% of participants reported pain relief on average of 25.4 weeks at time of follow-up. 41% reported side effects including suboccipital hyperesthesia and/or ear discomfort, 95% reported willingness to repeat the procedure again if severe symptoms recurred, 59% of patients reported the most recent RF ablation had the same results as the first, 32% reported the most recent RF was the most effective, and 9% reported that the first RF was the most effective. Conclusion: Repeated RF ablation is a feasible option for recurrent cervicogenic headaches and/or occipital neuralgia. Effectiveness of repeat intervention is the same or better than the first ablation. Though there was a higher likelihood of side effects including suboccipital neuralgia and/or ear discomfort on repeat treatment, the side effects were generally well tolerated.

关键词： occipital neuralgia Cervicogenic Headache Radiofrequency Ablation

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