Spinal Nerves

Notalgia paresthetica (NP) https://doi.org/10.5281/zenodo.20139369 is a chronic, localized neuropathic dysesthesia that presents as unilateral, often intractable pruritus over the medial scapula, typically corresponding to the posterior rami of spinal nerves T2 through T6. First described by Astwazaturow in 1934, NP remains underrecognized in general practice, leading to diagnostic delays, unnecessary testing, and patient frustration. The condition is benign in terms of mortality but significantly impairs quality of life through sleep disruption, secondary skin changes from chronic scratching, and psychological distress. The etiology remains incompletely understood. A central conceptual tension exists between radicular theoriesimplicating degenerative spinal pathology causing nerve root compression-and peripheral biomechanical models, which emphasize the angle at which cutaneous sensory fibers pierce the paraspinal muscles. Most likely, NP arises from a multifactorial interplay of structural predisposition, repetitive microtrauma, and dysregulated central itch processing. Histopathologically, NP shows secondary changes only: hyperkeratosis, post-inflammatory melanosis, melanophage infiltration, and sometimes secondary amyloid deposition. Diagnosis is clinical, requiring careful history to exclude dermatologic, systemic, and other neuropathic mimickers. Imaging is rarely necessary. Therapeutic outcomes remain disappointing. Gabapentin is the most consistently effective oral agent, while topical capsaicin, transcutaneous electrical nerve stimulation, and physical therapy show variable benefit in select patients. Antihistamines are notably ineffective. Botulinum toxin A has yielded contradictory results. Complete remission is uncommon, but symptom control is often achievable with patience and a trial-informed approach. An interprofessional team-including neurology, dermatology, primary care, pharmacy, and nursing-improves diagnostic accuracy and therapeutic success. This review synthesizes current evidence, clarifies conceptual frameworks, and offers practical guidance for the clinician confronting this challenging condition.

Many neurotransmitters involved in pain perception transmit signals via G protein-coupled receptors (GPCRs). GPCR kinase 2 (GRK2) regulates agonist-induced desensitization and signaling of multiple GPCRs and interacts with downstream molecules with consequences for signaling. In general, low GRK2 levels are associated with increased responses to agonist stimulation of GPCRs. Recently, we reported that in mice with reduced GRK2 levels, inflammation-induced mechanical allodynia was increased. In addition, mice with impaired interleukin (IL)-1b signaling did not develop mechanical allodynia after L5 spinal nerve transection (SNT). We hypothesized that in the L5 SNT model mechanical allodynia would be associated with reduced neuronal GRK2 levels in the spinal cord dorsal horn and that IL-1b signaling would be required to induce both the decrease in GRK2 and mechanical allodynia. We show here that in wild type (WT) mice L5 SNT induces a bilateral decrease in neuronal GRK2 expression in the lumbar spinal cord dorsal horn, 1 and 2 weeks after L5 SNT. No changes in GRK2 were observed in the thoracic segments. Moreover, spinal cord GRK2 expression was not decreased in IL-1R À/À mice after L5 SNT. These data show that IL-1b signaling is not only required for the development of mechanical allodynia, but also to reduce neuronal GRK2 expression. These results suggest a functional relation between the L5 SNT-induced IL-1b-mediated decrease in GRK2 and development of mechanical allodynia.

AIM: The aim of the work was to evaluate the voice quality of 10 adult patients after thyroplasty type I using a silicone block. Preoperatively patients suffered from unilateral vocal fold paralysis. MATERIAL AND METHODS: We evaluated selected preoperative and postoperative patient fi ndings (RBH according to Wendler classifi cation, videolaryngostroboscopy and maximum phonation time MPT). The evaluation was performed by a phoniatrician and clinical speech therapist, using patient medical records and the Lingwaves and Glottis Analysis Tools (GAT) programs. RESULTS: Preoperatively we identifi ed R1B1H1 -R3B3H3, postoperatively R0B0H0 -R3B3H2. In six cases the paralysed vocal cord was preoperatively in a paramedian position, twice in intermediate position and twice in a lateral position. In the case of 6 patients presbyphonic changes were present. Motility of the healthy vocal cord was within the norm. Postoperatively, the paretic vocal cord was medialised. We assessed the MPT value: preoperatively 3-10 seconds, postoperatively 9-17 seconds. Postoperatively we measured jitter (%), shimmer (%) and closing quotient values. In comparison with healthy subjects , jitter and shimmer values were higher and closing quotient values after thyroplasty type I close to normal values (Tab.1). CONCLUSIONS: The postoperative voice quality was signifi cantly better in comparison with the preoperative state; though, it never achieved the parameters of a normal voice. We confi rmed the signifi cant contribution of TPL I for the patients´ quality of life through partial rehabilitation of their voices. Text in PDF www.elis.sk.

AIM: The aim of the work was to evaluate the voice quality of 10 adult patients after thyroplasty type I using a silicone block. Preoperatively patients suffered from unilateral vocal fold paralysis. MATERIAL AND METHODS: We evaluated selected preoperative and postoperative patient fi ndings (RBH according to Wendler classifi cation, videolaryngostroboscopy and maximum phonation time MPT). The evaluation was performed by a phoniatrician and clinical speech therapist, using patient medical records and the Lingwaves and Glottis Analysis Tools (GAT) programs. RESULTS: Preoperatively we identifi ed R1B1H1 -R3B3H3, postoperatively R0B0H0 -R3B3H2. In six cases the paralysed vocal cord was preoperatively in a paramedian position, twice in intermediate position and twice in a lateral position. In the case of 6 patients presbyphonic changes were present. Motility of the healthy vocal cord was within the norm. Postoperatively, the paretic vocal cord was medialised. We assessed the MPT value: preoperatively 3-10 seconds, postoperatively 9-17 seconds. Postoperatively we measured jitter (%), shimmer (%) and closing quotient values. In comparison with healthy subjects , jitter and shimmer values were higher and closing quotient values after thyroplasty type I close to normal values (Tab.1). CONCLUSIONS: The postoperative voice quality was signifi cantly better in comparison with the preoperative state; though, it never achieved the parameters of a normal voice. We confi rmed the signifi cant contribution of TPL I for the patients´ quality of life through partial rehabilitation of their voices. Text in PDF www.elis.sk.

In cats, the monosynaptic reflex (MSR) elicited from L 7 or S1 dorsal roots, or from the tibial nerve (H reflex) was suppressed by vibration at 50-500 c/s of the hind limb with innervation intact. The MSR was not suppressed by selective vibration of cutaneous receptors, and suppression was still observed after the hind limb was skinned. In contrast, the phenomenon disappeared when all muscle nerves were crushed. Suppression of the MSR by vibration was shown to be mediated by presynaptic inhibition by the following methods: correlation with onset of the dorsal root potential (DRP) evoked by vibration, and abolition of both DRP and reflex suppression by picrotoxin; demonstration of primary afferent depolarization and normal excitability of motoneurones to direct stimulation. Reasons are given for deducing that the muscle afferent fibres respon- sible for the presynaptic inhibition induced by vibration are group Ia rather than groups Ib or II, or afferent fibres from Pacinian corpuscles.

Occipital neuralgia is a distinct neuropathic pain condition characterised by sudden, sharp, stabbing, or electric shock-like pain stemming from the distribution of the greater, lesser, or third occipital nerves. Usually beginning in the sub-occipital region, the pain radiates to the back of the scalp, vertex, or behind the eyes. Causes include nerve compression from muscular tension, cervical spine issues, trauma, poor posture, and idiopathic factors. Conventional treatments typically involve medications, nerve blocks, physiotherapy, and invasive procedures for refractory cases, which often offer only symptomatic relief rather than cure. Homoeopathy, grounded in individualization principles and the law of similars, provides a holistic approach to neuralgic conditions by addressing both functional disturbances and constitutional factors. While there is limited evidence from controlled clinical trials specific to occipital neuralgia, homoeopathic literature and clinical experiences highlight the effectiveness of remedies such as Aconitum napellus, Magnesium phosphoricum, Spigelia, Belladonna, Gelsemium, as well as lesser important remedies like Paris quadrifolia, Mezereum, and Cimicifuga racemosa in neuralgic pain. This review explores the clinical features, diagnostic considerations, and potential of individualized homoeopathic treatment for occipital neuralgia, with a focus on rare and less commonly used remedies. Further systematic research is necessary to develop evidence-based homoeopathic protocols for this challenging condition.

Background Hemicrania continua (HC) is a primary headache that comprises persistent unilateral pain, is associated with cranial autonomic features, and is responsive to indometacin. Some patients are unable to tolerate this treatment or it is contraindicated; for these patients, the medical options for therapy are restricted. Occipital nerve stimulation (ONS) is an eff ective treatment for medically intractable primary headache, but only three cases of HC treated with ONS have been reported. Here, we report long-term safety and effi cacy data for ONS in six patients with HC. ONS was provided by a unilateral neurostimulation device, known as a bion, which might be described as a second-generation ONS device. Methods Six patients aged 18 years or older who were diagnosed with HC had a suboccipital bion device implanted ipsilateral to their headache and received continuous unilateral ONS. A crossover study design was used: the bion was on for the fi rst 3 months, off for the fourth month, and on again during long-term follow-up. Detailed prospective headache diaries were kept for 1 month before implantation and for 5 months afterwards. Long-term data were obtained from patients' estimates of their outcome. The outcome of this study was assessed by a comparison of headache pain severity before and after ONS. Findings At a median follow-up of 13•5 months (range 6-21 months), fi ve of six patients reported suffi cient benefi t to recommend the device to other patients with HC. At long-term follow-up, four of six patients reported a substantial improvement (80-95%), one patient reported a 30% improvement, and one patient reported that his pain was worse by 20%. The onset of the benefi t of ONS was delayed by days to weeks, and headaches did not recur for a similar period when the device was switched off . Adverse events were mild and associated with transient overstimulation. Interpretation ONS appears to be a safe and eff ective treatment for HC, particularly when indometacin is not tolerated or is contraindicated. The bion device was well tolerated, easily inserted without signifi cant morbidity, and is one-twentieth of the volume of current devices. Such miniaturised devices are a potential new option for treatment of HC.

Spontaneously hypertensive rats (SHR) exhibit enhanced pressor, heart rate, and nociceptive responses to spinal nicotinic agonists. This accompanies a paradoxical decrease in spinal nicotinic receptor number in SHR compared with normotensive rats. The congenic strain, SHR-Lx, with an introgressed chromosome 8 segment from the normotensive Brown-Norway-Lx strain (BN-Lx) exhibits reduced blood pressure. This segment contains a gene cluster for three nicotinic receptor subunits expressed in the nervous system. We examined the implication of this gene cluster in the enhanced responsiveness of the SHR. Pressor and nociceptive responses to spinal cytisine, a nicotinic agonist, were diminished in SHR-Lx. Moreover, with repeated administration, these responses desensitized faster in SHR-Lx and progenitor BN-Lx than in progenitor SHR/Ola. This implicates the gene cluster in both cardiovascular and nociceptive responses to spinal nicotinic agonists. Since diminished responsiveness to agonist ...

Fatty acid amide hydrolase (FAAH) is a degradative enzyme for a group of endogenous signaling lipids that includes anandamide (AEA). AEA acts as an endocannabinoid and an endovanilloid by activating cannabinoid and vanilloid type 1 transient receptor potential (TRPV1) receptors, respectively, on dorsal root ganglion (DRG) sensory neurons. Inhibition of FAAH activity increases AEA concentrations in nervous tissue and reduces sensory hypersensitivity in animal pain models. Using immunohistochemistry, Western blotting, and reverse transcription-PCR, we demonstrate the location of the FAAH in adult rat DRG, sciatic nerve, and spinal cord. In naive rats, FAAH immunoreactivity localized to the soma of 32.7 Ϯ 0.8% of neurons in L4 and L5 DRG. These were small-sized (mean soma area, 395.96 Ϯ 5.6 m 2 ) and predominantly colabeled with peripherin and isolectin B4 markers of unmyelinated C-fiber neurons; 68% colabeled with antibodies to TRPV1 (marker of nociceptive DRG neurons), and Ͻ2% colabeled with NF200 (marker of large myelinated neurons). FAAH-IR was also present in small, NF200-negative cultured rat DRG neurons. Incubation of these cultures with the FAAH inhibitor URB597 increased AEA-evoked cobalt uptake in a capsazepine-sensitive manner. After sciatic nerve axotomy, there was a rightward shift in the cell-size distribution of FAAH-immunoreactive (IR) DRG neurons ipsilateral to injury: FAAH immunoreactivity was detected in larger-sized cells that colabeled with NF200. An ipsilateral versus contralateral increase in both the size and proportion of FAAH-IR DRG occurred after spinal nerve transection injury but not after chronic inflammation of the rat hindpaw 2 d after injection of complete Freund's adjuvant. This study reveals the location of FAAH in neural tissue involved in peripheral nociceptive transmission.

Martorell's ulcer is an uncommon ischemic and extremely painful lesion located in the distal portion of the lower limb, resulting from severe systemic and poorly controlled hypertension. It is common in women between 50 and 70 years of age. The diagnosis is clinical and mostly belated, following exclusion of other causes. The response to treatment takes time and is unsatisfactory. A combination of several drugs associated with surgery may be required for wound healing. The authors present a case of Martorell's hypertensive ulcer, with emphasis on the diagnostic and therapeutic difficulties.

Background The specific research aims of this study included: 1) Conduct an epidemiologic analysis of recreational sports injuries among 1500 children, ages 5–11 in Florida: and 2) Utilize the computerized pediatric concussion tool from ImPACT Applications, Inc. for baseline and follow-up testing to better understand these injuries. This research followed a prospective surveillance design utilizing a large cohort of children, ages, 5–11, who play recreational football, soccer, and baseball/softball in Florida. The study venue was a large athletic facility in Hillsborough County, Florida. The sports observed were soccer (girls’ and boys’), baseball, softball, and football. Internal and external advisory boards were consulted throughout the study. Methods Certified Athletic Trainers (ATCs) were hired to use High School Reporting Information Online (RIO) for injuries and the Ipad-administered pediatric concussion tool developed by ImPACT Applications, Inc for baseline/follow-up concuss...

The advent of optogenetic tools has allowed unprecedented insights into the organization of neuronal networks. Although recently developed technologies have enabled implementation of optogenetics for studies of brain function in freely moving, untethered animals, wireless powering and device durability pose challenges in studies of spinal cord circuits where dynamic, multidimensional motions against hard and soft surrounding tissues can lead to device degradation. We demonstrate here a fully implantable optoelectronic device powered by near-field wireless communication technology, with a thin and flexible open architecture that provides excellent mechanical durability, robust sealing against biofluid penetration and fidelity in wireless activation, thereby allowing for long-term optical stimulation of the spinal cord without constraint on the natural behaviors of the animals. The system consists of a double-layer, rectangular-shaped magnetic coil antenna connected to a microscale in...

A case of infantile metachromatic leucodystrophy is described in which symptoms started at 1 year of age with weakness and hypotonus in the lower extremities. The electrophysiological status was typical of a polyneuropathy, showing fibrillation and a reduction of the nerve conduction velocity to 30 percent of the average for normal children of the same age. Clinical signs of a central lesion and mental regression were not evident until a year later. Nerve biopsy showed metachromatic granules in the phagocytes and in the Schwann cells, confirming the diagnosis of metachromatic leucodystrophy. In peripheral neuropathy in infancy without obvious cause, a nerve biopsy is the most appropriate method for diagnosis of the metachromatic leucodystrophy.

The superior colliculus (SC) is a visuomotor center involved in the autonomic reflex adjustments of eye movements in response to visual stimuli. Diabetes mellitus (DM) is known to affect some visual pathway structures, but few studies have assessed the effects of diabetes on the SC. The aim of this study was to investigate the ultrastructural changes of SC neurons in the early period of streptozotocin (STZ)-induced diabetes. The ultrastructure was assessed by transmission electron microscopy (TEM). Twenty male Sprague-Dawley rats were divided into two groups (n=10 per group) and were intraperitoneally injected with either STZ (60 mg/kg) in citrate buffer (pH 4.5) to induce DM or with buffer alone as a positive control. The rats were sacrificed 4 weeks after injection and the SC was processed for TEM. Most of the SC neurons in the DM group exhibited either chromatolysis or pyknosis. Chromatolytic neurons had an enlarged nucleus with some chromatin clumping and disruption of the cell membrane. These neurons also exhibited mitochondrial enlargement with rupture of the cristae, distended Golgi complexes and rough endoplasmic reticulum, and numerous secondary lysosomes. By contrast, the pyknotic neurons in the DM group exhibited severe chromatic condensation and dark electron-dense structures in the cytoplasm. The organelles were smaller and had an irregular outline. The neuropil of DM rats had coarse, irregular, swollen dendrites and axons, together with demyelination. In conclusion, this study has provided clear evidence of ultrastructural degeneration in the SC of STZ-induced DM rats. These ultrastructural changes might contribute to the impairments of autonomic eye movement, optokinetic and vestibulo-ocular reflexes, and vision-related learning and memory in patients with DM.