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Acute cervical pain syndrome resulting from suppressed sneezing

Authors:
Namyata Pathak at Kerala Ayurveda Academy, USA
Namyata Pathak
  • Kerala Ayurveda Academy, USA
Ashwinikumar Raut at Kasturba Health Society's Medical Research Center, Mumbai,India
Ashwinikumar Raut
  • Kasturba Health Society's Medical Research Center, Mumbai,India
Ashok D B Vaidya at Saurashtra University
Ashok D B Vaidya
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728 www.japi.org ©JAPI • VOL.56 • SEPTEMBER2008
Correspondence
AcuteCervicalPainSyndromeResultingfrom
SuppressedSneezing
Sir,
AuniquefundamentalconceptinAyurvedafor the
pathogenesisofmanydiseasesisPragnyaaparaadha–which
impliesthetransgressionofwisdom-resultinginunhealthy
thoughtsand actions.Oneof itssubsetis theill-advised
suppressionofnaturalurgesand certainreexescalled
‘Vegadhaarana’.Charaka describes specic dysfunctions
ordisorderswhichmayensuebythesuppressionof
individualreexes. Vegadhaaranaof asneezecanlead to
stinessoftheneck,headache,migraine,facialpalsyand
visualorauditory disturbances.There exist, in literature,
documentedclinicalreportsofsimilarcomplications. Here
wepresentacasereport ofacutecervicalpainsyndrome
afteranattempttocontrola sneeze, tocreateacademic
interest in Vegadhaarana.
A23yroldgirl,withalonghistory of allergicrhinitis
presentedwithacuteandpainfulspasticrestrictionof
allmovementsoftheneck,moreontherightside.Two
daysearlier,she had a sudden precipitation of a painful
spasmofthescaleno-trapeziuswhile tryingto suppress
anexplosivesneeze.Within a day,shedevelopedsharp
shootingpainontheright,alongthemedialarmand
forearmuptothepalmwhichwasaggravatedonabduction.
Onphysicalexamination,therewastenderstinessofthe
righttrapezius,andtendernessoverthe3rd,4th,5th cervical
spines.Thearmcouldonlybeelevatedventrallyupto100°,
lateralabductionwas40°andposteriorabductionwas
restrictedto30°.Thesensoryexaminationwassuggestive
of ne uroprax ia of th e right  median  nerve .Th e patie nt
wasadvisedforX-rayand MRI of the cervical spine, but
wasreluctantfortheinvestigation.The painful spasm,
unrelievedbyrepeatedcoldcompressionorconventional
musclerelaxantssubsidedgraduallyoveraperiodofthree
weekswitharesidualstinesslastingforeightweeks.
Other complications reported in literatureincludea
suddencervicalquadruplegiaduetoaC4/5discherniation
ina42yroldmanwhodevelopedweaknessandnumbness
inhisarmsandlegsimmediatelyfollowingaviolent
sneeze.1Despiteemergencyanteriorcervicaldiscotomyand
fusion,thepatientcontinuedtobequadriplegic.Itwould
beworthwhile to followupon those patients who have
baselinecervicalspondylosisandwhodeveloprepeated
boutsofsneezing;thismay aggravatethecomplaintsor
precipitatethem.
Apneumomediastinumandcervico-facialemphysema
hasbeenreported followingausefulobstruction nasal
sneeze.2 D elay ed t raum ati c ocu lar  emph yse ma af ter
sneezingandblowingthenosewasreportedina47yrold
manwithasurgicallyuntreatedfractureofthefacialbone.
Hedevelopedsevereexophthalmos,diplopiaandreduction
ofvision.Besides,innereardamageevenfacialnerveinjury
toocanoccurduetoasignicantpressure,causedbythe
suppressionofasneezewith a velocity of 300 mph.The
pressuregetstransmitted via the Eustachian tubetothe
middleear damagingtothemembranouslabyrinth.One
patienthaddevelopedsudden permanent sensorineural
heari ng loss. A nd anoth er had a se vere vert igo due t o
vestibularinjuryandneededsurgicalsectionofthetensor
tympanitendonforrelief.3
Sneezingisonlyoneofthethirteentypesofvegadhaarana
describedinAyurveda.Amongsttheothersthesuppression
of f latus  and bow el move ment c an be a  contr ibuto ry
factortoreverseperistalsisandagingdiverticulardisease.4
Sushrutacollectivelyreferstothesedysfunctionsas
Udaavarta,subsetsofwhichareintestinalcounterperistalsis
andthevesico-uretericreux.InAyurveda,healthyhabits
includetheconcernforsuddensuppressionofresponsesto
stimulicoupledwithself-restraintonexcessesorindulgence
infood,sex,exertionorsleep,asrecommendedbymodern
medicine.Itwouldbe interestingtoinvestigateclinically
theevents whichmayfollowthehabitualsuppressionof
urgeslikemicturition,belching,hunger,thirst,sleep,crying
and ejaculation. Vegadhaaranaproposedasapathogenic
factorinAyurvedamayoerashiftintheparadigmfor
understandingtheputativelesionscausedbydissipationof
thebuilt-upmassivepressureresultingfromasuppressed
reex.
NamyataPathak*,ARaut**,AVaidya***
*Jr.Research Fellow; **Director–ClinicalResearchand Visiting
Rheumatologist;***ResearchDirector;MMRC,KasturbaHealth
Socie ty, ICMR Ad vanced c entre for  Reverse  Pharmac ology in
TraditionalMedicine,MMRC(SJAD),KDesaiRoad,VileParle(W),
Mumbai–400056.
Received:1.10.2007;Revised:13.3.2008;Accepted:30.7.2008
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JOtolaryngol2006;35:355-7.
3. KozukaM,NakashimaT,FukutaS,YanagitaN.Innereardisordersdue
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