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CONSULT 1 | CONSULT 2 | CONSULT 3| CONSULT 4
Right MCA Aneurysm
Contributor:
Dr. Chris Ekong
Case 15
Age: 46
Sex: Female
History: No symptoms. Incidental aneurysm found on CT & Angio.
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Angiograms | ||
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Angiograms showing Right MCA Aneurysm |
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Now What?
Nothing?
Surgery?
Endovascular?
Presented by: Dr. Kris, Kumar Neurosurgeon, Regina
Age: 32
Sex: Male
History:
1996: Left Carpal Tunnel decompression.
1997: Progressive stiffness and numbness of left hand.
Physio, TENS, steroid ganglia blocks resulted in minor improvement.
1998: Full increase in pain. Patient cannot make a fist nor tolerate handshakes and cutting of the finger nails.
1999: Further deterioration. Fingers very stiff. Are kept in a partially closed fist position.
Sept 2000: Cervical Pisces spinal cord implant. Good response for 1 year. Function in hand improved.
Nov 2001: Complains of erratic stimulation and sudden jolts to her legs.
X-ray shows electrode 1/2 segment displaced down.
Due to the jolts, the patient does not like to turn on stimulation.
hence pain recurrance.
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Questions:
What do we do next?
How do we stop the erratic function and jolts to the lower limbs?
Presented by: Dr. Kris, Kumar Neurosurgeon, Regina
Age: 52
Sex: Male
History:
Sept 1997:
Grade III compound fractured distal in the left humerous.
Total loss of radial and partial of median and ulner nerves.
Open reduction and plating of fracture - repair of nerves
Sept 1998:
No useful function in upper limbs.
Developed RSD.
Multiple sympathetic and stellate ganglia block. Poor response.
could not feel someone touch his hand or the draft from the air conditioning.
Sept 1999:
Below elbow amputation. RSD persists.
Revised - above elbow amputation. No pain relief. MRI of cervical spine - normal.
Nov 2000:
Cervical spinal implant for RSD.
70% pain relief in upper limbs
Mid 2001:
RSD under control with spinal cord stimulation. Now developed phantom limb pain.
Jan 2002:
Various injections to stump and sympathetic blocks. Physio - no relief.
March 2002:
Phantom limb pain persists.
MRI
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Questions:
What do we do next?
Options:
Deep brain implant.
Motor cortex stimulation
Intrathecal drug delivery pump implant.
