P012: ACUTE CVA SYMPTOMS AFTER REMOVAL OF OCCIPITAL NERVE STIMULATOR IN PATIENT WITH REFRACTORY OCCIPITAL NEURALGIA
Reena John, DO1, Jacob Topher, MS2, Jack Klem1, Rohin Sarkar3, Ahmed Salim, MS-32; 1Kendall Regional Medical Center, 2Nova Southeastern University COM, 3Aventura Hospital and Medical Center
Case Report: 36 yo F with PMH of occipital neuralgia, epilepsy, and chronic regional pain syndrome (CRPS), s/p placement of occipital/cervical nerve stimulator. She presented with of her left flank wound, s/p prior revision, presenting with recurrent prolapse od electrode lead, requiring removal of the entire occipital nerve stimulator system. Pt was given option of conservative management vs. removal and pt opted for removal and healing prior to insertion of new nerve stimulator.
Management: Pt was taken to OR, and nerve stimulator was removed without any immediate complications. Pt placed on IV vancomycin and admitted to the floor. Later that day, rapid response was called 2/2 pt’s AMS, new onset facial droop, global aphasia, and seizure. She was given Ativan and intubated. CT head and MRI were ordered to rule out acute CVA. CT head and MRI brain showed no evidence of acute infarct or intracranial hemorrhage. There was also evidence of LLE weakness and pt became bradycardic, NIR and cardiologist were consulted. Cardiac workup was negative, and NIR exam negative.
Chronic daily headache is a major worldwide health problem that affects 3–5% of the population and results in substantial disability.
Occipital neuralgia (ON) is the third most common headache syndrome following migraine and tension-type headache. I
Occipital nerve stimulation (ONS) is a promising treatment for patients with medically intractable, highly disabling chronic headache disorders, including migraine, cluster headache and other less common headache syndromes.
ONS could restore the balance within the impaired central pain system through slow neuromodulatory processes in the pain neuromatrix.
Direct effects of neurostimulation on peripheral nerve fiber excitability, including transient slowing of conduction velocity leading to increase in electrical threshold and decrease in response probability
Gate-control theory of pain which proposes that the activation of large diameter afferent nerve fibers in the spinal dorsal horn inhibit transmission in small diameter afferent nociceptive fibers, preventing the nociceptive signals from reaching the higher neural centers
A stimulation trial is performed before the permanent implantation.
ONS is a relatively safe procedure.
Reported adverse events include lead migration, lead site pain, myofascial incision site pain, neck stiffness, discharged battery, battery site pain and contact dermatitis.