Slade John Benjamin, Kwan Nathan, Lennox Peter, Gray Russell
David Grant USAF Medical Center, Travis Air Force Base, Fairfield, CA, United States.
Front Neurol. 2024 Mar 13;15:1364716. doi: 10.3389/fneur.2024.1364716. eCollection 2024.
Thalamic pain syndrome is a distressing type of central post-stroke pain (CPSP) that occurs in up to 10% of cases following a cerebrovascular accident, typically with a delayed onset of signs and symptoms, and is often chronic or even life-long. Thalamic pain syndrome, as is the case for other CPSPs, is difficult to treat, and the response is typically moderate at best. Central pain also occurs after vascular insults in parts of the CNS other than the thalamus. Only a few patients present with the classic "Dejerine and Roussy syndrome," so the term CPSP is preferred for describing neuropathic pain after stroke. There are no pathognomonic features of this syndrome. The thalamus probably has a substantial role in some patients with central pain, either as a pain generator or by abnormal processing of ascending input. Long-term post-stroke pain disorders can reduce the quality of life, affect mood, sleep, and social functioning, and can lead to suicide. Hemi-body pain is common in patients with thalamic lesions. Hyperbaric oxygen has known physiologic and pharmacologic effects with documented benefits in brain-related hemorrhages, acute and chronic stroke, traumatic brain injury, mild cognitive impairment, neurodegenerative diseases, and neuroprotection, but has never been reported as a treatment for thalamic pain syndrome. A 55-year-old man with a history of migraines suffered a right thalamic lacunar infarction following a brain angiogram to investigate a suspected AVM found on prior imaging that resulted in immediate left-sided weakness and numbness, evolving to severe chronic pain and subsequent stiffness. Diagnosed with thalamic pain syndrome, multiple pharmacologic therapies provided only partial relief for a year after the stroke. The patient's symptoms resolved and quality of life markedly improved with hyperbaric oxygen therapy, as assessed by multiple validated questionnaires, thus it may be a treatment option for thalamic pain syndrome.
丘脑痛综合征是一种令人痛苦的中枢性卒中后疼痛（CPSP），在脑血管意外后高达10%的病例中出现，通常症状和体征出现较晚，且往往是慢性的甚至是终生的。与其他CPSP一样，丘脑痛综合征难以治疗，反应通常充其量只是中等程度。中枢性疼痛也可发生于丘脑以外的中枢神经系统其他部位的血管损伤后。只有少数患者表现为典型的“德热里纳和鲁西综合征”，因此CPSP一词更适合用于描述卒中后的神经性疼痛。该综合征没有特异性特征。丘脑可能在一些中枢性疼痛患者中起重要作用，要么作为疼痛发生器，要么通过对上行输入的异常处理。长期的卒中后疼痛障碍会降低生活质量，影响情绪、睡眠和社交功能，并可能导致自杀。半身疼痛在丘脑病变患者中很常见。高压氧具有已知的生理和药理作用，在脑相关出血、急性和慢性卒中、创伤性脑损伤、轻度认知障碍、神经退行性疾病和神经保护方面有文献记载的益处，但从未被报道可用于治疗丘脑痛综合征。一名有偏头痛病史的55岁男性在进行脑血管造影以检查先前影像学发现的疑似动静脉畸形时，发生了右侧丘脑腔隙性梗死，导致立即出现左侧无力和麻木，随后发展为严重的慢性疼痛和僵硬。被诊断为丘脑痛综合征，多种药物治疗在卒中后一年仅提供了部分缓解。通过多项经过验证的问卷评估，高压氧治疗使患者症状缓解，生活质量明显改善，因此它可能是丘脑痛综合征的一种治疗选择。
