Role of the Qst-Testing for the Determination of the Nervus Intermedius Neuralgia Phenotype – Case Report

Bruno Vítor Martins Santiago; Carlos Darcy Alves Bersot; Fernando Cardoso de Lemos Souza; Odilea Rangel Gonçalves; Nivaldo Ribeiro Villela

doi:doi:10.11648/j.ijacm.20190701.12

Role of the Qst-Testing for the Determination of the Nervus Intermedius Neuralgia Phenotype – Case Report

Bruno Vítor Martins Santiago, Carlos Darcy Alves Bersot, Fernando Cardoso de Lemos Souza, Odilea Rangel Gonçalves, Nivaldo Ribeiro Villela

Published in International Journal of Anesthesia and Clinical Medicine (Volume 7, Issue 1)

Received: 24 November 2018 Accepted: 26 December 2018 Published: 28 February 2019

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Abstract

Background and Objectives: Nervus Intermedius neuralgia is a rare and difficult to suspect entity. This study aims to present the case of intermedius neuralgia, discusses the implications of the phenotype in the patient approach, as well as the role of quantitative susceptibility testing (QST), as an important tool in the diagnosis and therapeutic management. Case report: 40-year-old female patient, smoker, accompanied by neurology (generalized tonic-clonic seizures), in use of carbamazepine. During one of the seizures, she said fall from height, resulting in fracture of the left temporal bone and ipsilateral facial paralysis. After to optimal the therapy, she had no more seizures, but evolved with paroxysmal pain, shock-like, located in the groove between the ear and scalp at high intensity, with shooting area in the wall of the external auditory channel. Reports that had more crisis with the arrival of winter. The examination revealed mechanical hyperalgesia and "wind-up" phenomenon on the affected side. CT mastoid with evidence of temporal fracture to the left crossing the mast cells. Electroneuromyography corroborating with peripheral facial paralysis. Other tests without changes. It was submitted to the QST-test, evidencing hyperalgesia to cold in the region corresponding to the pain complaint. Lamotrigine was associated with the treatment regimen with 90% improvement of symptoms. Conclusion: This is a rare etiology and difficult diagnosis. The QST-test was extremely important, as well as aid in the diagnosis also allows us to identify the great variability of phenotypic profile within each etiology, which may reflect distinct pathophysiological mechanisms, with different therapeutic responses. There is evidence that lamotrigine assist in the treatment of neuropathic pain associated hyperalgesia to cold.

Published in	International Journal of Anesthesia and Clinical Medicine (Volume 7, Issue 1)
DOI	10.11648/j.ijacm.20190701.12
Page(s)	7-12
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

QST, Nervus Intermedius, Neuropathic Pain, Lamotrigine, Phenotype

References

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Bruno Vítor Martins Santiago, Carlos Darcy Alves Bersot, Fernando Cardoso de Lemos Souza, Odilea Rangel Gonçalves, Nivaldo Ribeiro Villela. (2019). Role of the Qst-Testing for the Determination of the Nervus Intermedius Neuralgia Phenotype – Case Report. International Journal of Anesthesia and Clinical Medicine, 7(1), 7-12. https://doi.org/10.11648/j.ijacm.20190701.12

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Bruno Vítor Martins Santiago; Carlos Darcy Alves Bersot; Fernando Cardoso de Lemos Souza; Odilea Rangel Gonçalves; Nivaldo Ribeiro Villela. Role of the Qst-Testing for the Determination of the Nervus Intermedius Neuralgia Phenotype – Case Report. Int. J. Anesth. Clin. Med. 2019, 7(1), 7-12. doi: 10.11648/j.ijacm.20190701.12

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Bruno Vítor Martins Santiago, Carlos Darcy Alves Bersot, Fernando Cardoso de Lemos Souza, Odilea Rangel Gonçalves, Nivaldo Ribeiro Villela. Role of the Qst-Testing for the Determination of the Nervus Intermedius Neuralgia Phenotype – Case Report. Int J Anesth Clin Med. 2019;7(1):7-12. doi: 10.11648/j.ijacm.20190701.12

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@article{10.11648/j.ijacm.20190701.12,
  author = {Bruno Vítor Martins Santiago and Carlos Darcy Alves Bersot and Fernando Cardoso de Lemos Souza and Odilea Rangel Gonçalves and Nivaldo Ribeiro Villela},
  title = {Role of the Qst-Testing for the Determination of the Nervus Intermedius Neuralgia Phenotype – Case Report},
  journal = {International Journal of Anesthesia and Clinical Medicine},
  volume = {7},
  number = {1},
  pages = {7-12},
  doi = {10.11648/j.ijacm.20190701.12},
  url = {https://doi.org/10.11648/j.ijacm.20190701.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20190701.12},
  abstract = {Background and Objectives: Nervus Intermedius neuralgia is a rare and difficult to suspect entity. This study aims to present the case of intermedius neuralgia, discusses the implications of the phenotype in the patient approach, as well as the role of quantitative susceptibility testing (QST), as an important tool in the diagnosis and therapeutic management. Case report: 40-year-old female patient, smoker, accompanied by neurology (generalized tonic-clonic seizures), in use of carbamazepine. During one of the seizures, she said fall from height, resulting in fracture of the left temporal bone and ipsilateral facial paralysis. After to optimal the therapy, she had no more seizures, but evolved with paroxysmal pain, shock-like, located in the groove between the ear and scalp at high intensity, with shooting area in the wall of the external auditory channel. Reports that had more crisis with the arrival of winter. The examination revealed mechanical hyperalgesia and "wind-up" phenomenon on the affected side. CT mastoid with evidence of temporal fracture to the left crossing the mast cells. Electroneuromyography corroborating with peripheral facial paralysis. Other tests without changes. It was submitted to the QST-test, evidencing hyperalgesia to cold in the region corresponding to the pain complaint. Lamotrigine was associated with the treatment regimen with 90% improvement of symptoms. Conclusion: This is a rare etiology and difficult diagnosis. The QST-test was extremely important, as well as aid in the diagnosis also allows us to identify the great variability of phenotypic profile within each etiology, which may reflect distinct pathophysiological mechanisms, with different therapeutic responses. There is evidence that lamotrigine assist in the treatment of neuropathic pain associated hyperalgesia to cold.},
 year = {2019}
}

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TY - JOUR
T1 - Role of the Qst-Testing for the Determination of the Nervus Intermedius Neuralgia Phenotype – Case Report
AU - Bruno Vítor Martins Santiago
AU - Carlos Darcy Alves Bersot
AU - Fernando Cardoso de Lemos Souza
AU - Odilea Rangel Gonçalves
AU - Nivaldo Ribeiro Villela
Y1 - 2019/02/28
PY - 2019
N1 - https://doi.org/10.11648/j.ijacm.20190701.12
DO - 10.11648/j.ijacm.20190701.12
T2 - International Journal of Anesthesia and Clinical Medicine
JF - International Journal of Anesthesia and Clinical Medicine
JO - International Journal of Anesthesia and Clinical Medicine
SP - 7
EP - 12
PB - Science Publishing Group
SN - 2997-2698
UR - https://doi.org/10.11648/j.ijacm.20190701.12
AB - Background and Objectives: Nervus Intermedius neuralgia is a rare and difficult to suspect entity. This study aims to present the case of intermedius neuralgia, discusses the implications of the phenotype in the patient approach, as well as the role of quantitative susceptibility testing (QST), as an important tool in the diagnosis and therapeutic management. Case report: 40-year-old female patient, smoker, accompanied by neurology (generalized tonic-clonic seizures), in use of carbamazepine. During one of the seizures, she said fall from height, resulting in fracture of the left temporal bone and ipsilateral facial paralysis. After to optimal the therapy, she had no more seizures, but evolved with paroxysmal pain, shock-like, located in the groove between the ear and scalp at high intensity, with shooting area in the wall of the external auditory channel. Reports that had more crisis with the arrival of winter. The examination revealed mechanical hyperalgesia and "wind-up" phenomenon on the affected side. CT mastoid with evidence of temporal fracture to the left crossing the mast cells. Electroneuromyography corroborating with peripheral facial paralysis. Other tests without changes. It was submitted to the QST-test, evidencing hyperalgesia to cold in the region corresponding to the pain complaint. Lamotrigine was associated with the treatment regimen with 90% improvement of symptoms. Conclusion: This is a rare etiology and difficult diagnosis. The QST-test was extremely important, as well as aid in the diagnosis also allows us to identify the great variability of phenotypic profile within each etiology, which may reflect distinct pathophysiological mechanisms, with different therapeutic responses. There is evidence that lamotrigine assist in the treatment of neuropathic pain associated hyperalgesia to cold.
VL - 7
IS - 1
ER -

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Author Information

Bruno Vítor Martins Santiago

Department of Anesthesiology, Medical Sciences College at Pedro Ernesto University Hospital, University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
Carlos Darcy Alves Bersot

Department of Anesthesiology, Medical Sciences College at Pedro Ernesto University Hospital, University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
Fernando Cardoso de Lemos Souza

Department of Anesthesiology, Medical Sciences College at Pedro Ernesto University Hospital, University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
Odilea Rangel Gonçalves
Nivaldo Ribeiro Villela

Department of Anesthesiology, Medical Sciences College at Pedro Ernesto University Hospital, University of the State of Rio de Janeiro, Rio de Janeiro, Brazil

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Bruno Vítor Martins Santiago, Carlos Darcy Alves Bersot, Fernando Cardoso de Lemos Souza, Odilea Rangel Gonçalves, Nivaldo Ribeiro Villela. (2019). Role of the Qst-Testing for the Determination of the Nervus Intermedius Neuralgia Phenotype – Case Report. International Journal of Anesthesia and Clinical Medicine, 7(1), 7-12. https://doi.org/10.11648/j.ijacm.20190701.12

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Bruno Vítor Martins Santiago; Carlos Darcy Alves Bersot; Fernando Cardoso de Lemos Souza; Odilea Rangel Gonçalves; Nivaldo Ribeiro Villela. Role of the Qst-Testing for the Determination of the Nervus Intermedius Neuralgia Phenotype – Case Report. Int. J. Anesth. Clin. Med. 2019, 7(1), 7-12. doi: 10.11648/j.ijacm.20190701.12

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Bruno Vítor Martins Santiago, Carlos Darcy Alves Bersot, Fernando Cardoso de Lemos Souza, Odilea Rangel Gonçalves, Nivaldo Ribeiro Villela. Role of the Qst-Testing for the Determination of the Nervus Intermedius Neuralgia Phenotype – Case Report. Int J Anesth Clin Med. 2019;7(1):7-12. doi: 10.11648/j.ijacm.20190701.12

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@article{10.11648/j.ijacm.20190701.12,
  author = {Bruno Vítor Martins Santiago and Carlos Darcy Alves Bersot and Fernando Cardoso de Lemos Souza and Odilea Rangel Gonçalves and Nivaldo Ribeiro Villela},
  title = {Role of the Qst-Testing for the Determination of the Nervus Intermedius Neuralgia Phenotype – Case Report},
  journal = {International Journal of Anesthesia and Clinical Medicine},
  volume = {7},
  number = {1},
  pages = {7-12},
  doi = {10.11648/j.ijacm.20190701.12},
  url = {https://doi.org/10.11648/j.ijacm.20190701.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20190701.12},
  abstract = {Background and Objectives: Nervus Intermedius neuralgia is a rare and difficult to suspect entity. This study aims to present the case of intermedius neuralgia, discusses the implications of the phenotype in the patient approach, as well as the role of quantitative susceptibility testing (QST), as an important tool in the diagnosis and therapeutic management. Case report: 40-year-old female patient, smoker, accompanied by neurology (generalized tonic-clonic seizures), in use of carbamazepine. During one of the seizures, she said fall from height, resulting in fracture of the left temporal bone and ipsilateral facial paralysis. After to optimal the therapy, she had no more seizures, but evolved with paroxysmal pain, shock-like, located in the groove between the ear and scalp at high intensity, with shooting area in the wall of the external auditory channel. Reports that had more crisis with the arrival of winter. The examination revealed mechanical hyperalgesia and "wind-up" phenomenon on the affected side. CT mastoid with evidence of temporal fracture to the left crossing the mast cells. Electroneuromyography corroborating with peripheral facial paralysis. Other tests without changes. It was submitted to the QST-test, evidencing hyperalgesia to cold in the region corresponding to the pain complaint. Lamotrigine was associated with the treatment regimen with 90% improvement of symptoms. Conclusion: This is a rare etiology and difficult diagnosis. The QST-test was extremely important, as well as aid in the diagnosis also allows us to identify the great variability of phenotypic profile within each etiology, which may reflect distinct pathophysiological mechanisms, with different therapeutic responses. There is evidence that lamotrigine assist in the treatment of neuropathic pain associated hyperalgesia to cold.},
 year = {2019}
}

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