Jang Sung Ho, Kim JongHoon, Lee Han Do
Department of Physical Medicine and Rehabilitation.
Department of Neurosurgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea.
Medicine (Baltimore). 2018 Dec;97(50):e13533. doi: 10.1097/MD.0000000000013533.
Recent studies have used diffusion tensor tractography (DTT) to demonstrate that central poststroke pain (CPSP) was related to spinothalamic tract (STT) injury in patients with stroke. However, few studies have been reported about delayed-onset CPSP due to degeneration of the STT following a stroke.
PATIENT'S CONCERNS: A 57-year-old female patient presented with right hemiparesis after stroke. Two weeks after onset, she did not report any pain. At approximately 6 months after onset, she reported pain in the right arm and leg, and the pain slowly intensified with the passage of time. At 14 months after onset, the characteristics and severity of her pain were assessed to be continuous pain without allodynia or hyperalgesia; tingling and cold-sensational pain in her right whole arm and leg (visual analog scale score: 5).
The patient was diagnosed as the right hemiparesis due to spontaneous thalamic hemorrhage.
Clinical assessment and diffusion tensor imaging (DTI) were performed 2 weeks and 14 months after onset.
She suffered continuous pain in her right whole arm and leg (visual analog scale score: 5). On DTT of the 2-week postonset DTI scans, the configuration of the STT was well-preserved in both hemispheres. However, in contrast to those 2-week postonset results, the 14-month postonset DTT results showed partial tearing and thinning in the left STT. Regardless, both the 2-week and 14-month postonset DTT showed that the left STT passed through the vicinity of the thalamic lesion.
Diagnostic importance of performing a DTT-based evaluation of the STT in patients exhibiting delayed-onset CPSP following intracerebral hemorrhage.
最近的研究使用弥散张量纤维束成像（DTT）证明，中风后中枢性疼痛（CPSP）与中风患者的脊髓丘脑束（STT）损伤有关。然而，关于中风后STT退变导致迟发性CPSP的研究报道较少。
一名57岁女性患者中风后出现右侧偏瘫。发病两周后，她未报告任何疼痛。发病约6个月后，她报告右侧手臂和腿部疼痛，且疼痛随时间缓慢加剧。发病14个月后，评估其疼痛特征和严重程度为持续性疼痛，无感觉异常或痛觉过敏；右侧整个手臂和腿部有刺痛和冷感疼痛（视觉模拟评分：5分）。
该患者被诊断为自发性丘脑出血导致的右侧偏瘫。
在发病后2周和14个月进行了临床评估和弥散张量成像（DTI）。
她右侧整个手臂和腿部持续疼痛（视觉模拟评分：5分）。在发病后2周的DTI扫描的DTT上，双侧半球的STT形态保存完好。然而，与发病后2周的结果相比，发病后14个月的DTT结果显示左侧STT有部分撕裂和变细。尽管如此，发病后2周和14个月的DTT均显示左侧STT穿过丘脑病变附近。
对脑出血后出现迟发性CPSP的患者进行基于DTT的STT评估的诊断重要性。
