Central Post Stroke Pain: The Clinical-Anatomical Correlations from Pain Clinic Stories

Arūnas Ščiupokas*^1,2,3, Eglė Sukockienė¹ and Gintarė Žemgulytė¹

Received: November 21, 2018;   Published: December 03, 2018

DOI: 10.26717/BJSTR.2018.11.002133

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Abstract

Unless a significant proportion of post stroke patients are not treated adequately, the sensory phenotype based management is proposed in the article. We evaluated three case stories of cerebral infarcts resulted to thalamic pain syndromes. The somatosensory examination each of them has found different sensory signs of thermalgesic and deep sensation, depending on where lesion occurred. In case of extra-thalamic cause of CPSP (patient 3) pain was associated with dissociated thermalgesic sensory loss due to preserved lemniscal function. Classic thalamic pain (patient 2) was accompanied by non-dissociated sensory symptoms, and the damage of the spinothalamic and dorsal column-medial lemniscal pathways altogether (patient 1) has showed loss of all sensory modalities. The study confirms that examination of sensory function is essential for diagnosis of central neuropathic pain. We think that a proper pain evaluation and long-term follow-up of stroke survivors is necessary for successful management of CPSP.

Keywords : Central Post-Stroke Pain; Clinical-Anatomical Approach; Sensory Phenotype Based Management

Abbreviations : CPSP: Central Post Stroke Pain, NRS: Numeric Rating Scale, HADS: Hospital Anxiety and Depression, MRI: Magnetic Resonance Imaging, HAD: Hospital Anxiety and Depression, LPQ: Lithuanian Pain Questionnaire, PICA: Posterior Inferior Cerebellar Artery, NRS: Numeric Rate Scale