CONSULT 1 | CONSULT 2 | CONSULT 3| CONSULT 4

CONSULT 1

Presented by:  Dr. Chris Ekong Neurosurgeon, Regina

Age:  22    Sex:  Female

History:

• Cerebral hemorrhage at 10 months

• Quadruparetic and blind for 2 years.

• Recovered almost completely.

• Now has had headaches for 2 years.

• MRI shows midbrain enhancing lesion.

MRI of Brain

CT of Brain

CT of brain with contrast			CT of brain without contrast

Question:

1. What is it?

2. How do we treat it?

CONSULT 2

Presented by:  Dr. Robert Brownstone, Neurosurgeon, Halifax

Age:  42

Sex:  Male

History:

• Referred for post-brachial plexus injury pain otherwise healthy.

• Neurontin 6g/d, Topamax 75 mg/d, Elavil 50 mg/d

• Jan/01 – snowmobile accident, completely avulsed right brachial plexus C5-T1

• other injuries: # 9 ribs, # scapula, pulmonary contusion
• R leg initially paralysed, largely recovered
• No sensorimotor function in arm
• Electrodiagnositics – injury proximal to DRG
• Pain from elbow down, fingers feel as if they’re "blowing off", elbow "crushed"
• Narcotic unresponsive

MRI

Jan 22/02 – trial of SCS (longshot), failed – aggravated pain

Question:

1. DREZotomy?

CONSULT 3

Presented by: Dr. Kris, Kumar Neurosurgeon, Regina

Age:  28

Sex:  Female

History: 

• 1980 - Received a right brachial plexus injury when thrown against the boards playing ringette.

• 1981-92 - Developed chronic dislocation of right shoulder.  Multiple stabilization operations.

• 1994 - Right shoulder fused.

• 1995 - Developed R.S.D.  Trial of Spinal cord stimulation - using temporary lead, Superior electrode at C-4 - for three weeks.  Good pain relief.  Developed epidural abscess.  Treated by antibiotics and removal of lead.

• May 2001 - Lamintomy - insert resume lead & internalization using Itrel III in Winnipeg.  Super electrode at C-5.  No relief.

• August 2001 Electrode Re-explored.  

• Could not be moved up.  

• Extension wire of electrode damaged and cut.

• The pulse generator still in place

• No pain relief - needs large doses of narcotics

Questions:

1. What do we do next?

2. How do we move the electrode superiorly to C-4?

3. Any other method of pain relief?