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Atypical painful stroke presentations: A review
Michael Bayat1, Allan Bayat2, Rolf A Blauenfeldt3
1Department of Neurology & Centre for Rare Diseases, Aarhus University Hospital, Aarhus, Denmark.
Acta Neurologica Scandinavica
|July 5, 2022
Summary
Stroke can rarely present as initial neurogenic pain, affecting the face or body. This pain may precede other stroke symptoms like hemiparesis, indicating a need for careful neurological evaluation.
Area of Science:
- Neurology
- Neuroscience
- Pain Medicine
Background:
- Stroke is a major cause of death and disability worldwide.
- Atypical presentations of stroke are recognized, with neurogenic pain being a rare initial symptom.
- Understanding these rare presentations is crucial for timely diagnosis and management.
Purpose of the Study:
- To review and summarize current knowledge on stroke presenting with acute pain.
- To identify common pain characteristics and associated neurological deficits.
- To correlate pain location with specific brain lesion sites.
Main Methods:
- A narrative review of studies and case series.
- Inclusion criteria focused on patients with pain at stroke onset or within 24 hours.
- Exclusion of cases related to vessel dissection, venous thrombosis, or CNS vasculitis.
Main Results:
- Neurogenic pain can manifest as trigeminal neuralgia, facial pain, or sensory pain, often described as burning.
- Pain may be episodic, transient, or persistent, sometimes heralding other stroke symptoms like hemiparesis.
- Lesion locations vary: thalamus, brainstem, insula, or parietal lobe for trunk/extremity pain; pons for facial pain.
Conclusions:
- Stroke can present atypically with neurogenic pain, requiring a high index of suspicion.
- Specific pain patterns and locations can suggest particular stroke lesion sites.
- Early recognition of pain as a stroke symptom is vital for prompt intervention.
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