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Título

PULSED RADIOFREQUENCY FOR POST-COVID OCCIPITAL NEURALGIA: A CASE REPORT

RESUMO

Case Report Patient, 45 years old, male, history of infection by Covid-19, was attended at an outpatient neurosurgery service complaining of pain in the occipital and cervical region, of strong intensity, paroxysmal, burning type. On physical examination, he had more marked paresthesia on the right and a positive Tinel's sign on the right. Test blockade of the greater and lesser occipital nerves with anesthetic solution showed improvement in the condition for 4 days. From the diagnosis of post-Covid-19 Occipital Neuralgia, he underwent neuromodulation therapy with pulsed radiofrequency in the C2 dorsal root ganglion, at a temperature of 42°C, for 3 minutes, with repetition after an interval of 3 minutes. The procedure was uneventful, with complete resolution of pain and hospital discharge on the same day. Discussion In regard to chronic neuropathic pain, there are reports of it being triggered by psychological stressors, viral infection or as a result of hospitalization in the intensive care unit. There are post-viral immunological reactions capable of promoting an environment conducive to the establishment of neurological complications. Neural virulence would likely be linked to violations of the blood-brain barrier, either by endothelial invasion through the binding of the virus's Spike protein to the angiotensin-2-converting enzyme, or trans-synaptically through the invasion of the olfactory nerves, or even an increase in the permeability of the barrier caused by the release of cytokines resulting from the systemic inflammatory process as a reactional response. Pulsed radiofrequency consists of radiofrequency emission by a catheter through an electrode, positioned close to a nociceptive pathway, in short pulses, leaving intervals between emissions in order to allow the affected tissue to cool. The area affected can be well defined, being restricted to the nerves responsible for transmitting and modulating painful sensations. In the case of occipital neuralgia, the electrode implant is placed in the C2 ganglion, where greater and lesser occipital nerves emerge, thus allowing pulsed and non-continuous waves to induce a low-intensity electric field around these nerves, aiming to modulate and regulate the activity of A-delta fibers and C fibers. Final Comments Occipital neuralgia implies a careful investigation and carries a vast possibility of treatments, among them, pulsed radiofrequency neuromodulation acquires notoriety along with its promising results.

Palavras Chave

Post COVID-19 chronical pain, Occipital Neuralgia, Pulsed Radiofrequency