http://www.jucm.com/2007-oct/insights3.shtml

Sandel,

The delineation is amazing in that photo. It is like someone has drawn a line to separate the good area from the bad!
Good to see that she did get some relief with blocks!
Cheers Tayla

It is sad to read: The patient was treated for the acute symptoms in the urgent care setting with the standard of care ...and does not have a very good prognosis, as this entity tends to get worse despite treatment.

It may be that even after 140 years, the appropriate treatment for a neurological dysfunction hasn't been found, or it might be that the medical profession is treating the wrong disease.

It's interesting, to say the least, that the author chose to include the words: Though this could easily be mistaken for an infectious process, it was actually reflex sympathetic dystrophy (RSD), as my next major post will describe why the acute stage of this disease is easily mistaken for an infectious process. [emphasis added].

The post I'm working on now explains why our immune response to trauma is exactly the same as the immune response to infections of every sort. It will tell you why RSD almost always begins with the spreading inflammation we see in these pictures...Vic

Thanks for posting this, it was a very interesting article. Her bad arm looked horrible, it was really swollen.
It's nice to know that she did get some pain relief from blocks. I am very sorry that the prognosis is not good for her.
Wishing you all well
Alison

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There is no cure, but there IS hope.

[QUOTE=Vicc;157679]It is sad to read: [SIZE=3][COLOR=blue][SIZE=2][COLOR=black


Vicc,
You said

It may be that even after 140 years, the appropriate treatment for a neurological dysfunction hasn't been found, or it might be that the medical profession is treating the wrong disease.

I am wondering why then did this lady exhibit sings of improvement for some time following nerve blocks if there wasn't a neurological element to the disease?
The fact that she relapsed may well have been due to ineffectual care from her doctor rather than the wrong care.



You also said

It's interesting, to say the least, that the author chose to include the words: Though this could easily be mistaken for an infectious process, it was actually reflex sympathetic dystrophy (RSD), as my next major post will describe why the acute stage of this disease is easily mistaken for an infectious process. [emphasis added].


I gather that the fact she was given a definitive diagnosis of CRPS when it did look like an infection, that she would have had all the appropriate blood tests to eliminate the possibility of there being an infective or inflammatory process happening.
She obviously showed NONE of the usual markers for infection or inflammation such as raised CRP, WCC, ESR or there would never have been a nerve block administered but Antibiotics instead.

I am wondering if you could address how this could be an IRI when the face and neck is such a very odd place to have ever experienced an ischaemic event?


In my opinion the photos show very clearly the flush of vasomotor changes due to a sympathetic/autonomic nerve supply disorder.There are not too many disorders that present with such delineation but a sympathetic disorder is one.


Regards
Tayla

Tayla,

I am wondering why then did this lady exhibit sings of improvement for some time following nerve blocks if there wasn't a neurological element to the disease? Interesting thoughts, but we know that blocks do provide temporary relief; the problem is that no one knows why. I don't have an answer either. At any rate, I don't deny that nerve damage is present in ischemia-reperfusion injury (IRI), I argue is is caused by ischemia.

The fact that she relapsed may well have been due to ineffectual care from her doctor rather than the wrong care. From what I understand, blocks provide temporary relief and just about everyone relapses. Perhaps when looked at objectively, blocks are ineffectual except to provide temporary relief.

I am wondering if you could address how this could be an IRI when the face and neck is such a very odd place to have ever experienced an ischaemic event? IRI is actually an ischemia-reperfusion-ischemia injury, with the 2nd ischemia different from the initiating ischemia. At the acute stage, ischemia is caused by inflammation, so it hasn't yet become the reperfusion ischemia of IRI. In this light, she is not yet experiencing the direct ischemia, but still in the inflammatory stage of the disease.

In my opinion the photos show very clearly the flush of vasomotor changes due to a sympathetic/autonomic nerve supply disorder. Is it your opinion that this redness can only be caused by a sympathetic/autonomic nerve supply disorder, and not by inflammation?

There are not too many disorders that present with such delineation but a sympathetic disorder is one. Does the disorder you talk about have a name? Can you provide some documentation describing this disorder?

Finally, IRI is, among other things, a nerve supply disorder, but that doesn't begin until later, after the 2nd ischemia begins. It isn't part of the acute stage...Vic

Vicc,


You asked about the name of the disorder in which there is unilateral flushing with marked deliniation.---The disease is called Harlequin Syndrome. This is a disease in which there is neurovascular compression of the sympathetic chain.
I have seen this several times in my career.
There are numerous sites on the disorder, one being www.nature.com/ncpneuro/journal/v1/full/ncpneuro.


You also asked whether I thought that redness can ONLY be caused by sympathetic dysfunction? I can't imagine what would make you ask that because I acknowledged that inflammation and infection also cause redness of the skin. In fact it is probably the most usual cause, it just was NOT the cause in the story that Sandel posted.

I am quite confused with the diagnosis of IRI as I believed it was describing the damage done to tissue when it has been reperfused following a period of ischaemia and am wondering how this equates to a nerve disease?
I know and have seen IRI and yes there can be some nerve damage but we should not confuse the peripheral nerve damage that may occur due to death by ischaemia with the nervous systom dysfunction that occurs in RSD/CRPS.
The blood supply to our skin is regulated by our autonomic/sympathetic system, whether it be vasoconstriction or vasodilation (which causes the flushing)
It stands to reason if there is prolonged or frequent vasoconstriction then there maybe tissue damage as a result---this is obvious in the trophic changes we often have.


You have also stated that nerve blocks are an ineffectual method of treating RSD/CRPS and there is usually relapse.
Vicc, whilst this may be your experience (I am not sure if you have had blocks or not) but there are many documented stories from people on this site from people who have had great success with them and it IS well documented that EARLY intervention with blocks is known to bring about a remission or cure for some people.
It seems that the ability of the patient to get prompt and appropriate attention from a well informed, proactive medical team is tantamount to the outcome.


Tayla