A 35-year-old black man, an immigrant from Nigeria who had been living in Spain for 6 months, complained of progressive burning pain on the right side of his chest and weakness on the ipsilateral leg for 1 year. Until recently, he had been using hot water to relieve his severe chest pain because he did not have painkillers. A 15-cm scar due to a burn injury was evident on physical examination (Figure 1). A neurological examination revealed a suspended decrease in pain and temperature perception between T3 and T10 dermatomes, and light touch and vibration sensation decreased in the lower limbs and exaggerated deep tendon reflexes in both legs without Babinski sign. Magnetic resonance imaging of the spine showed an 8-cm intraspinal mass on the cervicodorsal region, which presented as a heterogeneous enhancement after the administration of a contrast agent, and a syringomyelic cavity (Figure 2). A histopathological examination established the diagnosis of ependymoma.
Rico M, Ramón C, Santamarta E, Pascual J, Morís G. A Painless Burn Due to Lack of Painkillers. JAMA Neurol. 2014;71(2):240–241. doi:10.1001/jamaneurol.2013.2192