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Abstract Details

Balance and pain scores improve after occipital nerve blocks from cranio-cervical trauma.
Neuro Trauma, Critical Care, and Sports Neurology
P11 - Poster Session 11 (8:00 AM-9:00 AM)
5-011
NA
Concussions can result from cranio-cervical trauma. Cranio-cervical trauma frequently leads to post-traumatic occipital neuritis. Occipital neuritis can trigger symptoms similar to concussions. We will show that patients who have occipital neuritis/neuralgia secondary to cranio-cervical trauma obtain improvement in both pain and balance with occipital nerve block injections.
Retrospective cohort study of patients who have sustained cranio-cervical trauma. We reviewed records of our patients for diagnosis of concussion, presence of occipital neuritis, and imbalance. Before and after blocks, balance was quantified using number of errors in tandem stance (maximum of 10 points) and number of steps in tandem gait with eyes open then eyes closed (up to 10 steps each). Also, pain was measured using a 100mm visual analog scale (VAS).  Blocks were a combination of lidocaine, bupivacaine, and either triamcinolone or methylprednisolone. Blocks were placed over the greater occipital nerve, lesser occipital nerve, and third occipital nerve, on each side that had pain elicited.
205 patients had ages ranging 4-85 years of age. Occipital nerve blocks with steroids showed reduction in mean VAS pain scores from 39.6mm to 24.9mm (P<0.001). Tandem stance assessment of balance showed reduction of errors from 3.9 to 1.2 (P<0.001). Steps taken during tandem gait showed increase in the mean from 8 to 9 steps (P<0.001) and 4.3 to 6.2 (P<0.001) for eyes opened and eyes closed respectively.

After the blocks, there was a significant difference in pain and improvement in both static/dynamic balance in these patients who had occipital neuritis. What is the prevalence of occipital neuritis in concussions? How do we differentiate concussion from occipital neuritis symptoms? Pain and balance are found in each disorder, but with occipital nerve blocks, we are able to alleviate both symptoms. Therefore, it is important to evaluate for both concussion and occipital neuritis when assessing cranio-cervical trauma.
Authors/Disclosures
Brittany L. Poinson, MD (Tulane University)
PRESENTER 		Dr. Brand- Poinson has nothing to disclose.
No disclosure on file
Andrew T. Guidry, MD (Ochsner Health System) Dr. Guidry has received personal compensation in the range of $500-$4,999 for serving as a Ringside Physician with Maryland State Athletic Commission. Dr. Guidry has received personal compensation in the range of $500-$4,999 for serving as a Fact Witness with Legal Cases.
Kevin E. Crutchfield, MD Dr. Crutchfield has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Ryan,Ryan and Deluca.