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      Comparison of the Clinical Effectiveness Between Infrared Thermography and Electrophysiology Tests in Spinal Intradural Extramedullary Schwannoma

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          Abstract

          Objective

          Subjective pain is experienced differently by each patient; therefore, modalities that can objectify subjective symptoms are useful. Electrophysiology tests and infrared (IR) thermography can present subjective symptoms in an objective manner. This study aimed to compare the effectiveness of electrophysiology tests and IR thermography in patients with intradural extramedullary (IDEM) schwannoma and statistically analyze the results to verify the positive relationship between the subjective neurologic symptoms and test results.

          Methods

          We retrospectively analyzed the data from 23 patients, pathologically confirmed to have IDEM spinal schwannoma after surgery between January 2012 and December 2020. All patients were preoperatively examined using IR thermography and an electrophysiology test. IR thermography was conducted again week after operation. The IR thermography results were classified as either positive or negative.

          Results

          Radiculopathy symptoms were reported in 16 cases and myelopathy in 7 cases. Among the radiculopathy patients, 9 out of 16 (56.2%) showed positive electrophysiology test results. Among the myelopathy patients, 2 out of 7 (28.5%) showed positive electrophysiology test results. In the radiculopathy group, 15 out of 16 (93.7%) patients showed positive IR thermography results. In the myelopathy group, 2 out of 7 (28.5%) patients showed positive IR thermography results. The correlation between the IR thermography and electrophysiology test was analyzed. In the radiculopathy group, positive electrophysiology test result was obtained in 8 out of 15 (53.5%) patients with positive IR thermography result.

          Conclusion

          In patients with IDEM schwannoma presenting radiculopathy symptoms, IR thermography is a complementary tool to objectify the neurological symptoms.

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          Most cited references25

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          ThermoTRP channels and beyond: mechanisms of temperature sensation.

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            Assessment of autonomic dysreflexia in patients with spinal cord injury.

            To assess the impairment of supraspinal control over spinal sympathetic centres and the occurrence of autonomic dysreflexia in patients with spinal cord injury. Autonomic dysreflexia is caused by the disconnection of spinal sympathetic centres from supraspinal control and is characterised by paroxysmal hypertensive episodes caused by non-specific stimuli below the level of the lesion. Therefore, patients with spinal cord injury were examined clinically and by different techniques to assess the occurrence of autonomic dysreflexia and to relate disturbances of the sympathetic nervous system to episodes of autonomic dysreflexia. None of the paraplegic patients, but 59% (13/22) of tetraplegic patients (91% of the complete, 27% of the incomplete patients) presented signs of autonomic dysreflexia during urodynamic examination. Only 62% of the tetraplegic patients complained about symptoms of autonomic dysreflexia. Pathological sympathetic skin responses (SSRs) of the hands were related to signs of autonomic dysreflexia in 93% of cases. No patient with preserved SSR potentials of the hands and feet showed signs of autonomic dysreflexia, either clinically or during urodynamic examination. Ambulatory blood pressure measurements (ABPMs) indicated a loss of circadian blood pressure rhythm (sympathetic control) but preserved heart rate rhythm (parasympathetic regulation) only in patients with complete tetraplegia. Pathological ABPM recordings were seen in 70% of patients with symptoms of autonomic dysreflexia. The urodynamic examination was more sensitive in indicating signs of autonomic dysreflexia in patients with spinal cord injury, whereas SSR allowed the assessment of the degree of disconnection of the sympathetic spinal centres from supraspinal control. Using ABPM recordings the occurrence of episodes of autonomic dysreflexia over 24 hours and the effectiveness of therapeutical treatment can be assessed.
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              Cortical, thalamic, and hypothalamic responses to cooling and warming the skin in awake humans: a positron-emission tomography study.

              Thermoregulatory mechanisms are remarkably efficient, ensuring minimal temperature variation within the core of the human body under physiological conditions. Diverse afferent and efferent neural pathways contribute to the monitoring of core and skin temperature, generation of heat, and control of thermal exchange with the external environment. We have investigated the cortical, thalamic, and hypothalamic responses to cooling and warming by using positron-emission tomography activation imaging of subjects clad in a water-perfused suit, which enabled rapid change of their skin-surface temperature. Human brain regions that respond to changes in skin temperature have been identified in the somatosensory cortex, insula, anterior cingulate, thalamus, and hypothalamus, with evidence that the hypothalamic response codes for the direction of temperature change. We conclude that signals from thermosensors in the skin providing crucial afferent information to the brain are integrated with signals from central thermosensors, resulting in thermoregulatory responses that maintain core temperature within a remarkably narrow range.
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                Author and article information

                Journal
                Korean J Neurotrauma
                Korean J Neurotrauma
                KJN
                Korean Journal of Neurotrauma
                Korean Neurotraumatology Society
                2234-8999
                2288-2243
                October 2022
                01 September 2022
                : 18
                : 2
                : 306-313
                Affiliations
                Department of Neurosurgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
                Author notes
                Address of correspondence: Sung Hwa Paeng. Department of Neurosurgery, Inje University Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan 47392, Korea. shpaeng@ 123456empas.com
                Author information
                https://orcid.org/0000-0001-8060-8937
                https://orcid.org/0000-0002-8903-9117
                https://orcid.org/0000-0002-3112-5354
                https://orcid.org/0000-0002-3737-3850
                https://orcid.org/0000-0002-3537-3080
                https://orcid.org/0000-0002-6578-6361
                https://orcid.org/0000-0002-7389-3714
                Article
                10.13004/kjnt.2022.18.e38
                9634310
                03fc3d88-5a33-43a9-9f29-58eea80f0b2b
                Copyright © 2022 Korean Neurotraumatology Society

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 18 February 2022
                : 28 June 2022
                : 19 July 2022
                Categories
                Current Issue
                Clinical Article

                schwannoma,electrophysiology,thermography
                schwannoma, electrophysiology, thermography

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