Successful Treatment of Complex Regional Pain Syndrome with Pseudoaneurysm Excision and Median Nerve Neurolysis.
BACKGROUND
Complex regional pain syndrome (CRPS), formerly referred to as reflex sympathetic dystrophy, is a pain syndrome characterized by severe pain, altered autonomic and motor function, and trophic changes. CRPS is usually associated with soft tissue injury or trauma. It has also been described as a rare complication of arterial access for angiography secondary to pseudoaneurysm formation.


METHODS
A 73-year-old woman underwent catheterization of the left brachial artery for angiography of the celiac artery. The following day, the patient noticed numbness and severe pain in the median nerve distribution of the left upper extremity. Over the next 6 months, the patient developed CRPS in the left hand with pain and signs of autonomic dysfunction. Further work-up revealed the formation of a left brachial artery pseudoaneurysm with impingement on the median nerve. She underwent excision of the pseudoaneurysm with decompression and neurolysis of the left median nerve. Approximately 6 weeks after surgery, the patient had noticed significant improvement in autonomic symptoms.


CONCLUSIONS
This case involves a unique presentation of CRPS caused by brachial artery angiography and pseudoaneurysm formation. In addition, the case demonstrates the efficacy of pseudoaneurysm excision and median nerve neurolysis in the treatment of CRPS as a rare complication of arterial angiography.
Department of Neurosurgery, New York Medical College, Valhalla, New York, USA. Electronic address: johnlgillickmd@gmail.com.
John L
JL
Gillick
Department of Neurosurgery, New York Medical College, Valhalla, New York, USA.
Jared B
JB
Cooper
Department of Neurosurgery, New York Medical College, Valhalla, New York, USA.
Sateesh
S
Babu
Department of Neurosurgery, New York Medical College, Valhalla, New York, USA.
Kaushik
K
Das
Department of Neurosurgery, New York Medical College, Valhalla, New York, USA.
Raj
R
Murali
D000368:Aged; D017541:Aneurysm, False / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000601:surgery; D020918:Complex Regional Pain Syndromes / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D020423:Median Neuropathy / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D018608:Ultrasonography, Doppler
Angiography; Complex regional pain syndrome; Median neuropathy; Pseudoaneurysm