Michel D, Laurent B, Convers P, Garcia-Larrea L, Le Bas J F, Mauguiere F, Schott B
Service de Neurologie, Hôpital Bellevue, CHU de Saint-Etienne.
Rev Neurol (Paris). 1990;146(6-7):405-14.
Vascular lesions of the cerebral cortex sparing the thalamus (MRI or CT with reconstructions) may be accompanied by burning or constrictive pain which suggests thalamic pain as it affects one half of the body and is associated with induced pain. Summation hyperpathia is rare; allodynia is more common and sometimes isolated (2 cases). Cortical pain may be paroxysmal, and in 3 of our patients it progressed like a jacksonian seizure. The territory of pain is also the site of global or spinothalamic hypoaesthesia (5 cases). Early SEPs are abolished or of low amplitude (8 cases). The lesion is located in area SI or extends to the thalamo-parietal radiations; in 11 out of 12 patients it was located in the minor hemisphere. Two physiopathological theories are discussed: hyperactivity of the intralaminar thalamus relieved from cortical inhibition, or denervation hyperactivity related to the cortical or subcortical lesion.
大脑皮层血管病变不累及丘脑（MRI或CT重建）可能伴有灼痛或紧缩性疼痛，这种疼痛提示丘脑痛，因为它影响身体的一侧，且与诱发性疼痛相关。总和性痛觉过敏罕见；感觉异常更常见，有时是孤立性的（2例）。皮层痛可能是阵发性的，在我们的3例患者中，其进展类似杰克逊癫痫发作。疼痛区域也是整体或脊髓丘脑束感觉减退的部位（5例）。早期体感诱发电位消失或波幅降低（8例）。病变位于第一躯体感觉区或延伸至丘脑-顶叶辐射区；12例患者中有11例病变位于非优势半球。文中讨论了两种病理生理学理论：解除皮层抑制后丘脑板内核的活动亢进，或与皮层或皮层下病变相关的去神经活动亢进。
