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A hidden mesencephalic variant of central pain
Philippe Convers1,2, Christelle Creac'h1,2,3, Albert Beschet4
1Central Integration of Pain Unit, Lyon Centre for Neurosciences (CRNL), INSERM U1028, UCB Lyon 1, UJM Saint Etienne, Saint Etienne, France.
European Journal of Pain (London, England)
|May 19, 2020
Summary
Central post-stroke pain (CPSP) can result from rare midbrain lesions affecting the spinothalamic tract. These mesencephalic injuries, often hemorrhagic, can cause neuropathic pain and may be misdiagnosed.
Area of Science:
- Neurology
- Pain Medicine
- Neuroscience
Background:
- Central post-stroke pain (CPSP) typically arises from lesions in the central somatosensory pathways, particularly the spinothalamic system (STS).
- CPSP has not been previously described in cases of pure midbrain infarcts, despite the STS being potentially injured in this region.
Purpose of the Study:
- To describe a series of patients who developed central post-stroke pain due to lesions specifically located in the postero-lateral mesencephalon.
- To highlight the characteristics and diagnostic challenges of mesencephalic CPSP.
Main Methods:
- Retrospective analysis of over 300 consecutive CPSP cases.
- Detailed clinical and electrophysiological evaluation (laser-evoked potentials) of five patients with mesencephalic lesions.
Main Results:
- Five patients developed neuropathic pain from lesions confined to the postero-lateral mesencephalon.
- Lesions were hemorrhagic, involved the spinothalamic tract (STT), and suppressed laser-evoked potentials.
- Pain was initially misdiagnosed as psychogenic in two cases due to subtle sensory deficits.
Conclusions:
- Postero-lateral midbrain lesions are a potential, albeit rare, cause of CPSP.
- Mesencephalic CPSP can be misdiagnosed due to subtle clinical signs and imaging difficulties, leading to delayed diagnosis.
- Electrophysiological testing is crucial for confirming STT involvement in suspected mesencephalic CPSP.
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