Jang Sung Ho, Seo You Sung
Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Republic of Korea.
Medicine (Baltimore). 2019 Feb;98(6):e14306. doi: 10.1097/MD.0000000000014306.
Headache is the most common physical complaint reported by the following traumatic brain injury (TBI). Several studies using diffusion tensor tractography (DTT) have demonstrated that injury of the spinothalamic tract (STT) is a pathogenetic mechanism of central pain following TBI. However, no study of headache due to injury of the STT has been reported.
Patient 1 was a 52-year-old female who suffered head trauma resulting from an in-car traffic crash. While sitting in a passenger seat in a moving vehicle, another vehicle suddenly hit the car from the right side. Her head hit the door and she suffered a flexion-hyperextension-rotation injury. She began to feel headaches in both fronto-parieto-occipital areas approximately 2 weeks after the crash. The characteristics and severity of pain were as follows: constant tingling and intermittent stabbing pain without allodynia or hyperalgesia (visual analogue scale score: 7). Patient 2 was a 50-year-old male who suffered head trauma from a flexion-hyperextension injury that occurred after being hit from behind by a vehicle while driving his car. He began to feel headache in both fronto-parieto-occipital areas the day after the crash: constant tingling pain without allodynia or hyperalgesia (visual analogue scale score: 6).
The patient 1 was diagnosed as mild TBI due to head flexion-hyperextension-rotation injury. The patient 2 was diagnosed as mild TBI due to head flexion-hyperextension injury.
Clinical assessment and DTT were performed at 5 months (patient 1) and 10 months (patient 2) after the initial injury.
On DTTs of patient 1 and 2, the STTs showed narrowing in both hemispheres. In addition, discontinuations at the subcortical white matter were observed in both hemispheres in patient 2.
Headache due to injury of the STT was diagnosed in patients with mild TBI. Precise diagnosis of central pain from other types of pain is clinically important because the management of central pain is quite different from those for other types of pain. Our results suggest that headache might be ascribed to the injury of the STT in patients with mild TBI. Therefore, we recommend evaluation of the STT using DTT in patients with mild TBI who complain of headache having the characteristics of neuropathic pain.
头痛是创伤性脑损伤（TBI）后最常见的身体不适主诉。多项使用弥散张量纤维束成像（DTT）的研究表明，脊髓丘脑束（STT）损伤是TBI后中枢性疼痛的发病机制。然而，尚无关于STT损伤所致头痛的研究报道。
患者1为一名52岁女性，因车内交通事故头部受伤。坐在行驶车辆的乘客座位上时，另一辆车突然从右侧撞上该车。她的头部撞到车门，遭受了屈曲-过伸-旋转损伤。车祸后约2周，她开始感到双侧额顶枕部头痛。疼痛的特点和严重程度如下：持续性刺痛和间歇性刺痛，无感觉异常或痛觉过敏（视觉模拟评分：7分）。患者2为一名50岁男性，在驾车时被车从后方撞击，因屈曲-过伸损伤头部受伤。车祸后第二天，他开始感到双侧额顶枕部头痛：持续性刺痛，无感觉异常或痛觉过敏（视觉模拟评分：6分）。
患者1因头部屈曲-过伸-旋转损伤被诊断为轻度TBI。患者2因头部屈曲-过伸损伤被诊断为轻度TBI。
在初次受伤后5个月（患者1）和10个月（患者2）进行了临床评估和DTT检查。
在患者1和患者2的DTT图像上，双侧半球的STT均显示变窄。此外，患者2双侧半球的皮质下白质出现中断。
轻度TBI患者被诊断为STT损伤所致头痛。准确区分中枢性疼痛与其他类型的疼痛在临床上很重要，因为中枢性疼痛的治疗与其他类型的疼痛有很大不同。我们的结果表明，轻度TBI患者的头痛可能归因于STT损伤。因此，我们建议对主诉具有神经性疼痛特征头痛的轻度TBI患者使用DTT评估STT。
