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Neurally Mediated
Hypotension Abstract V
The Neurosurgical Subset of Fibromyalgia: Part I: Clinical Findings with
Neurally Mediated Hypotension
Rosner MJ, Bailey RK, Flechas J
Hendersonville, NC
BACKGROUND: Fibromyalgia is a syndrome characterized by low pain thresholds, but which may occasionally be a manifestation of surgically treatable disease. The hallmark of this subset of patients will be objective neurological abnormality.
OBJECTIVE: To define neurological abnormalities in patients who may be candidates for surgical decompression, to document symptomatic outcome at one-year after surgery (part II) and to document radiological differences between control and this subset of FMS patients (part III).
METHODS: Thirty-seven patients underwent protocol neurological and tilt table examinations that included a detailed neurological history/review of system and assessment of cranial nerve, motor, sensory, extrapyramidal and reflex evaluations. Each underwent a tilt table examination to objectively assess at least the cardiovascular component of the autonomic nervous system to restrict this subset to those with objectively defined organic disease.
RESULTS: Patients had been symptomatic for >10 years and on disability for an average of 4.9 years. Cranial Nerve deficits: 14/37 demonstrated unilateral or bilateral Homer’s syndrome. 21/37 had CN V abnormalities including absent corneal reflexes. 7/17 demonstrated CN VII abnormalities (not including dry eyes, dry mouth, or hyperacusis) and 17/37 had abnormalities of hearing (not including tinnitus). 20/37 had CN IX, X, XI abnormalities, most commonly absent gag reflex and oropharyngeal sensory changes. Abnormalities of convergence, nystagmus, head tilt, skew deviation, esophoria and tongue weakness were common. Upper extremity motor deficits were identified in 36/37 and 35/37 in the lower extremities. Hyper-, hypotonia and atrophy were frequent. 32/37 had abnormalities to pin, touch, vibration or tenperature sensation. 24/37 demonstrated hyperreflexia, and 17/37 demonstrated hyporeflexia. 34/37 had abnormalities of gait, 27/37 a positive Romberg’s sign and Babinski’s and Hoffman’s sign were present in 18 and 8 of the 37, respectively.
CONCLUSION: Neurological deficits can be identified in those patients with FMS and a positive tilt table examination. These deficits localize to the brainstem and upper cervical spinal cord, and when identified, should lead to a detailed radiological evaluation of these regions.
MYOPAIN 2001
Portland, Oregon
September 9-13
National Fibromyalgia Research Association
PO Box 500, Salem, OR 97308
