Consults
Consult 2 | Consult 3

Consult 1
Presenter: Dr. Christian Cloutier

Age: 44
Sex: Female
History:

  • 1995 2 minor knee injuries. Developed pain and stiffness and required investigation, arthroscopy, and local treatment.
  • Clinical signs of reflex sympathetic dystrophy started distally, mainly in the foot. Presented with severe cooling or burning pain, episodes of cramping, allodynia, edema, and a fixed foot with continous flexion of the toes (equinism). No relief using the usual theriputic tools.
  • MRI normal
  • Psychological evaluation normal.
  • X-Ray of foot showed mild demineralization.
  • November 99, Epidermal Stimulation (Medtronic Resume) mild benefit.
  • On last visit, encouraged to continue low voltage and long time stimulation. Baclofen medication was started.




Pre-op images

 



Intra-op images

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Consult 2
Presenter: Dr. K. Kumar, Neurosurgeon, Regina

Age: 71
Sex: Male
History:

  • Presented with ischemic hesrt disease with NYHA functional classification III-IV.

  • 1983 -- Had myocardial infarct.

  • 1984 -- Had bypass surgery.

  • 1994 -- Had angioplasty.

  • 1999 -- Presents with intractable angina -- Refractory to best medical treatment.

Left Ventriculogram(LVC).
Coronary Arteriogram.
Three vessel coronary artery disease and left main disease. Occlusion of saphenous vein graft to right coronary artery.

 
Intra-operative X-Ray showing spinal cord implant electrode.


Treatment:
  • Repeat coronary angiography shows that all grafts have occluded.

  • Revascularization by surgery or angioplasty not feasable.

Medication:
  • Fluvastatin -- 20mg o.d.
  • Metoprolol -- 200mg o.d.
  • Nitro patch -- 0.8mg in a.m.
  • Lisinopril -- 10mg o.d.
  • Diltiazem-CD -- 240mg o.d.
  • Glyburide -- 10mg o.d.
  • Nitroglycerin sublingual -- p.r.n

In spite of all the medications, pain persists everytime he walks in the room, dresses, or washes his mouth.

Question:
  1. How to manage his intractable angina? Spinal cord implant?


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Consult 3
Presenter: Dr. C. Ekong

Age: 33
Sex: Female
History:

  • Paraplegia with severe leg pains.

  • 1990 -- Started to get weakness in her legs -- Diagnosed with MS.

  • 1992 -- Confined to wheelchair and having flexor spasms and paraplegic pain.

  • Trial Morphine pump implant used -- did not ease pain.

  • Pump was then filled with Bacofen -- helped the flexor spasms, but not the intractable paraplegic pain.

  • 1997 -- Underwent a cordectomy of D7 level -- gave total relief of pain.

  • 1998 -- Pump was removed.

  • September, 1999 -- Recurrence of paraplegic pain.

MRI of T-space showing T8 cordectomy.

 
MRI of sections 5/6.

Question:
  1. How to manage her pain now?

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Last Updated: December 7, 1999
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