Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942004000100010
Brazilian Journal of Anesthesiology
Clinical Information

Gabapentina no tratamento da dor decorrente de cistos perineurais sacrais: relato de caso

Gabapentin to treat sacral perineural cyst-induced pain: case report  

Elza Magalhães; Ana Márcia Mascarenhas; Durval Campos Kraychete; Rioko Kimiko Sakata

Downloads: 0
Views: 1154

Resumo

JUSTIFICATIVA E OBJETIVOS: Os cistos perineurais podem gerar dor com características neuropáticas de difícil controle. Os anticonvulsivantes são medicações utilizados para tratamento de dores com essas características. O objetivo deste relato é mostrar um caso com total remissão da dor com uso de gabapentina após o insucesso no tratamento com todas as outras alternativas terapêuticas utilizadas. RELATO DE CASO: Paciente de 67 anos, diabética, com queixa de dor lombossacra há dois meses, com as seguintes características: diária, em pontada e queimação, de intensidade leve a moderada e com irradiação para região posterior da coxa. Piorava com o movimento e com a posição ortostática. Há seis meses havia tido um episódio semelhante de dor, que melhorou com o uso de corticoesteróides. A ressonância nuclear magnética da coluna lombossacra mostrava lesões císticas perineurais sacrais em S1, S2 e S3 com diâmetro de 2,5 a 4 cm, comprimindo o saco dural associado à erosão óssea. Foi introduzida a gabapentina em doses progressivas até 900 mg/dia, com alívio completo do quadro álgico. CONCLUSÕES: A dor neuropática provocada pelo cisto de Tarlov pode ser controlada de maneira adequada com gabapentina.

Palavras-chave

DOENÇAS, Neurológica, DOR, Crônica, DROGAS

Abstract

BACKGROUND AND OBJECTIVES: Perineural cysts may induce difficult to control neuropathic pain. Anticonvulsivants are used to treat such pain. This report aimed at presenting a case of total pain remission with gabapentin after failure of all other therapeutic alternatives used.
CASE REPORT: Female, diabetic patient, 67 years old, complaining of lumbosacral pain for two months, with the following characteristics: daily, sharp and burning pain of mild to moderate intensity irradiating to posterior thigh. Pain would worsen with movement and in the standing position. Six months before she had had a similar pain episode which improved with steroids. Lumbosacral spine MRI showed 2.5 cm sacral perineural cyst injuries at S1, S2 and S3, compressing the dural sac and associated to bone erosion. Gabapentin was introduced in progressive doses until 900 mg/day, with complete pain relief.
CONCLUSIONS: Tarlov's cyst neuropathic pain may be adequately controlled with gabapentin.

Keywords

DISEASE, Neurologic: perineural cysts; DRUGS: gabapentin; PAIN, Chronic

References

Yucesoy K, Naderi S, Ozer H. Surgical treatment of sacral perineural cysts: A case report. Kobe J Med Sci. 1999;45:245-250.

Voyadzis J, Bhangava P, Handerson FC. Tarlov cysts: a study of 10 cases with review of the literature. J Neurosurg. 2002;95:25-32.

Kim CH, Bak KH, Kim JM. Symptomatic sacral extradural arachnoid cysts associated with lumbar intradural arachnoid cyst. Clin Neurol Neurosurg. 1999;101:148-152.

Amoiridis G, Wohrle J, Przuntec H. Lumbosacral perineural cysts as cause for neurogenic muscular hypertrophy. Eletromyogr Clin Neurophysiol. 1997;37:273-275.

Rabb CH, McComb JG, Raffel C. Spinal arachnoid cysts in the pediatric age group: on association with neural defects. J Neurol. 1992;77:369-372.

Nedler SF, Bartoli LM, Stitik TP. Tarlov cyst as a rare cause of S1 radiculopathy: a case report. Arch Phys Med Rehabil. 2001;82:689-690.

Myles LM, Gupta N, Armstrong D. Multiple extradural arachnoid cysts as a cause of spinal cord compression in a child. J Neurosurg. 1999;91:116-120.

Nomo Y, Nanjo Y, Nagashima H. Sacral cysts managed with cysts - subarachnoid shunt. Spine. 2001;4:451-453.

Nicholson B. Gabapentin use in neuropathic syndromes. Acta Neurol Scand. 2000;101:359-371.

Mummaneni PV, Pitts LH, McCormack BM. Microsurgical treatment of symptomatic sacral Tarlov cysts. Neurosurgery. 2000;47:74-79.

MacPherson RD. The pharmacological basis of contemporary pain. Pharmacol. 2000;88:163-165.

Hays H, Woodroffe MA. Using gabapentin to treat neuropathic pain. Can Fam Physician. 1999;45:2109-2112.

Hernanez JL. Dados actuales sobre la gabapentina. Rev Neurol. 2000;301:125-131.

5dd7f7880e8825681a13f286 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections