Dr M S Chong MD FRCP
庄美生医生 MD FRCP

King Edward VII Hospital, Outpatient Medical Centre, 50-54 Beaumont Street, London, W1G 6DW
爱德华七世国王医院，门诊医疗中心，50-54 Beaumont Street，伦敦，W1G 6DW
The Spire Alexandra Hospital, Impton Lane, Walderslade, Kent ME5 9PG
The Spire Alexandra Hospital， Impton Lane， Walderslade， Kent ME5 9PG
KIMS Hospital, Newnham Court Road, Weavering, Bearsted, Kent ME14 5FT
KIMS 医院， Newnham Court Road， Weavering， Bearsted， Kent ME14 5FT
NHS Practice: NHS 实践：
The National Hospital for Neurology & Neurosurgery, Pain Management Centre, 25 Cleveland Street, London W1T 4AJ
国家神经病学与神经外科医院，疼痛管理中心，25克利夫兰街，伦敦 W1T 4AJ
CORRESPONDENCE: 24 CHURCH TERRACE, CHATHAM, KENT ME5 7JP
通信地址：24 CHURCH TERRACE， CHATHAM， KENT ME5 7JP
PA - Ms Tracey Wood - Tel: 01634328290 or 07790283494 Email: samchongpa@gmail.com
PA - Ms Tracey Wood - 电话： 01634328290 或 07790283494 电子邮件： samchongpa@gmail.com

16 June 2024 16 六月 2024
Clinic: 140624 KEVII 诊所： 140624 KEVII

Dear Lady Williams 尊敬的 Lady Williams
Re: Lady Sandra WILLIAMS 回复：Sandra WILLIAMS 夫人
T 01-268-4648393 E GovGenab@gmail.com
电话 01-268-4648393 E GovGenab@gmail.com

You told me you are 61-years-old and right-handed. You said your pain started in 2007, radiating from the neck into your left arm. You told me you wore a collar for some time and that appeared to help. You said you were investigated having had MRI scan and was told there might be some prolapsed cervical discs. You said these symptoms resolved spontaneously after about a month, but you then developed pain in your left upper back; you said these symptoms have persisted ever since.
你告诉我你 61 岁了，是右撇子。您说您的疼痛始于 2007 年，从颈部辐射到左臂。你告诉我你戴项圈有一段时间了，这似乎有帮助。您说您接受了 MRI 扫描检查，并被告知可能有一些颈椎间盘脱垂。您说这些症状在大约一个月后自发消退，但随后您的左上背部出现疼痛;你说这些症状从那时起就一直存在。

You told me this is a continuous searing burning pain in one specific area, made worse by cold and was previously alleviated for about an hour with $2\mathrm{\%}$$2\mathrm{\%}$2%2 \% lidocaine injections. You said that area of skin is actually numb. You described episodes of pain radiating down into your left thumb; you said this happens about once every three to four months, with each episode lasting about an hour; you have not found any trigger factors this for. You said the pain makes it difficult for you to sleep, it is distracting and your movements are more stilted as a result.
您告诉我，这是在一个特定区域持续的灼热灼痛，寒冷会使疼痛变得更糟，之前注射 $2\mathrm{\%}$$2\mathrm{\%}$2%2 \% 利多卡因后大约一个小时后可以缓解。你说那个皮肤区域实际上是麻木的。您描述了疼痛发作向下辐射到您的左手拇指;你说这大约每三到四个月发生一次，每次发作持续大约一个小时;您尚未找到任何触发因素。你说疼痛让你难以入睡，它分散了你的注意力，结果你的动作更加生硬。

You told me symptoms became worse recently when you sustained a traumatic head injury as a result of a fall in the hotel. You said you slipped, hit your head and then experienced a seizure. You described an acute seizure secondary to a traumatic brain injury. You said you still experience headaches once a week at present, usually in the frontal or occipital region; you told me this is a tight squeezing pain, 6 out of 10 in severity, alleviated after half an hour by taking ibuprofen. You told me there is no nausea or vomiting associated with this headache; it is not related to posture and there is no diurnal variation. You said you did have a CT brain scan and an intracranial bleed was ruled out.
你告诉我，最近你在酒店摔倒导致头部外伤，症状变得更糟了。你说你滑倒了，撞到了头，然后癫痫发作了。您描述了继发于创伤性脑损伤的急性癫痫发作。您说您目前仍然每周头痛一次，通常在额叶或枕部;你告诉我这是一种紧绷的挤压痛，严重程度为 6/10，半小时后服用布洛芬缓解。你告诉我这种头痛没有恶心或呕吐;它与姿势无关，也没有昼夜变化。您说您确实进行了脑部 CT 扫描，并排除了颅内出血。

In addition to this you told me you have also experienced dizziness and a sense of imbalance, particularly with head movements. You said your memory and concentration have been affected, making you less tolerant than usual.
除此之外，您告诉我您还经历过头晕和不平衡感，尤其是头部运动时。你说你的记忆力和注意力都受到了影响，让你比平时更不耐受。

You told me you have had numerous tests including $x$$x$xx-rays of the chest, cervical spine, MRI scan of the abdomen and pelvis, as well as CT scans. You said you were investigated at the Baptist Hospital in the United States, where you underwent lower cervical root injections which made no difference to your symptoms. You told me you were also investigated in Germany, but no conclusive diagnosis was made.
您告诉我您做了很多检查，包括 $x$$x$xx 胸部、颈椎、腹部和骨盆的 MRI 扫描，以及 CT 扫描。您说您在美国浸信会医院接受了调查，在那里您接受了下颈根注射，但您的症状没有影响。你告诉我你也在德国接受了调查，但没有做出结论性的诊断。

You said you are not known to be diabetic, and there is no other significant past medical history. You told me you are currently on Premarin, HRT and takes pethidine injections 75 mg on a prn basis to control the pain. You said you have no known allergies and do not smoke cigarettes. There is no family history of neurological disorders.
您说您不知道自己患有糖尿病，也没有其他重要的既往病史。你告诉我你目前正在服用 Premarin、HRT，并在 prn 的基础上服用 75 毫克的哌替啶注射剂来控制疼痛。您说您没有已知的过敏症，也不抽烟。无神经系统疾病家族史。

On examination you struggled to tandem walk. On Unterberger test you veered to the left. There was no papilloedema and cranial nerve examination was unremarkable. Tone and power was normal; all the reflexes were present; your plantar reflexes were unreactive. Vibration and pinprick sensation was normal in the extremities, but in the left paramedian region roughly between T6 to T10 there was a patch of numbness together with hyperalgesia to pinprick.
在检查时，你很难串联行走。在 Unterberger 测试中，您向左偏转。无视水肿，颅神经检查无明显异常。语气和力量正常;所有反射都存在;你的足底反射没有反应。四肢的振动和针刺感是正常的，但在大约 T6 到 T10 之间的左侧旁正中区域，有一小块麻木和针刺痛觉过敏。

I have made a diagnosis of notalgia paraesthetica. Although itch is the predominant symptom with this condition, it can also be associated with burning pain. In addition to this you have sustained at least a mild probable traumatic brain injury because you hit your head and proceeded to have an acute seizure afterwards. Thankfully we know that these seizures do not recur and are only due to the acute brain trauma that triggered the attack.
我已经诊断出 Notalgia paraesthetica。虽然瘙痒是这种情况的主要症状，但它也可能与灼痛有关。除此之外，您至少遭受了轻微的、可能的创伤性脑损伤，因为您撞到了头，之后又出现了急性癫痫发作。值得庆幸的是，我们知道这些癫痫发作不会复发，只是由于引发发作的急性脑外伤。

I propose further investigations to rule out any soft tissue abnormality, especially around the paraspinal muscles. I have arranged for you to have an MRI scan of your thoracic spine to include looking at the paraspinal soft tissues and MRI head with SWI sequences to look for evidence of a traumatic brain injury.
我建议进一步检查以排除任何软组织异常，尤其是椎旁肌肉周围。我已经安排您对胸椎进行 MRI 扫描，包括查看椎旁软组织和带有 SWI 序列的头部 MRI，以寻找创伤性脑损伤的证据。

I propose using lidocaine patch in the first instance and later on we can discuss the possibility of using capsaicin and/or Botox injections. You said you have tried gabapentin in the past but could not tolerate the side effects of this medication. You said you have not tried tricyclic drugs such as amitriptyline or SNRI medication duloxetine.
我建议首先使用利多卡因贴剂，稍后我们可以讨论使用辣椒素和/或肉毒杆菌毒素注射的可能性。您说您过去曾尝试过加巴喷丁，但无法忍受这种药物的副作用。您说您没有尝试过三环类药物，例如阿米替林或 SNRI 药物度洛西汀。

I thought you could also be helped with psychological pain management. The pain is real, but the effects of the pain causing distress frustrations tends to further exacerbate the discomfort.
我认为您也可以在心理疼痛管理方面得到帮助。痛苦是真实的，但疼痛造成痛苦、挫败感的影响往往会进一步加剧不适。

I have copied this letter to my colleague Dr Steve Coen so that you can discuss possible psychological techniques to help you cope with the pain and I am sure he will be able to see you remotely as well.
我已将这封信抄送给我的同事史蒂夫·科恩 （Steve Coen） 医生，以便您可以讨论可能的心理技巧来帮助您应对痛苦，我相信他也能够远程看到您。

You are due to fly back to Antigua next week and I will have another consultation with you probably over the telephone, to let you know the results of the scan.
您下周将飞回安提瓜，我可能会通过电话与您再次咨询，让您知道扫描结果。

Yours sincerely 此致
Electronically checked 电子检查
Dr M S Chong 庄明淑医生
Consultant Neurologist 神经科顾问医生

Cc: Dr Steven Coen 抄送：Steven Coen 博士
Chartered Clinical Psychologist
特许临床心理学家
3 Taviton Street 塔维顿街 3 号
Bloomsbury 布鲁姆斯伯里
London 伦敦
WC1H 0BT WC1H 0BT 系列