| Identifier |
Complex_Regional_Pain_Syndrome_Lee |
| Title |
Complex Regional Pain Syndrome |
| Creator |
Andrew G. Lee, MD; Anirudh Mukhopadhyay |
| Affiliation |
(AGL) Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, Texas; Professor of Ophthalmology, Weill Cornell Medicine, New York City, New York; (AM) Baylor College of Medicine, Houston, Texas |
| Subject |
Reflex; Sympathetic; Dystrophy; Pseudomotor; Edema; Redness |
| Description |
Dr. Lee lectures medical students on Complex Regional Pain Syndrome. |
| Transcript |
So, I want to talk to you about complex (you already know it's a problem) regional (which means it's just in one location) pain (but it's way more than pain) syndrome and I learned this as "reflex sympathetic dystrophy." And over time it's clear that this term is not explanatory enough to explain that the complexity of the situation as well as the syndromic nature of it: a lot of things end up with complex regional pain syndrome. The prototype of course is in people's hands and so they have all four of the modalities affected. So, the required criteria for a complex regional pain syndrome requires that we have deficits in not just the sensory, but in the pseudomotor fibers as well as the motor and then temperature color. So, the pseudomotor is the edema component. So, they're going to have, in your in your hand for example, you're going to have pain and it's going to have edema, be red, and there's going to be motor dysfunction as well or skin changes that are noticeable nail bed and hair, that are going to make the diagnosis a combination of not just the symptom of pain but the signs that there is neurogenic activity going on. So, for the face (that's how it comes to ophthalmology), there are periorbital versions of this complex regional pain disorder. Normally it occurs after some trauma, the imaging studies are usually negative, and the laboratory studies are negative. So, it's recurrent bounce of pain, numbness, and then the key and differentiating feature is the pseudomotor and the color. So, we'd like to take photographs to document the swelling and the color, which is going to be the redness. So, in the hand that's kind of easy to do, in the face we'd like to have selfies taken so we can see the asymmetry. The Pseudomonas manifestation is edema, and the color is redness. So, it'll be hot red swollen painful those are the inflammatory symptoms and signs. And now you can see why we used to call it reflex sympathetic dystrophy. Because it was thought that the vasodilation phase of the sympathetics was causing the pseudomotor, the color, and the temperature changes. So, it's probably central. There's some mechanism that is central involved here and it's not clear what this is. And then it manifests in a vicious cycle where you get sensory, pseudomotor, motor, and temperature dysregulation as a result of sympathetic activity in the affected limb usually the hand but it comes to us as ophthalmology because it can be in your face or even periorbital after minor trauma. |
| Date |
2022-03 |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Collection |
Neuro-Ophthalmology Virtual Education Library: Andrew G. Lee Collection: https://novel.utah.edu/Lee/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Rights Management |
Copyright 2019. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6dex88e |
| Setname |
ehsl_novel_lee |
| ID |
1751074 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6dex88e |
