Dysaesthesiae induced by physiological and electrical activation of posterior column afferents after stroke

Six of 48 stroke patients had functionally limiting dysaesthesiae induced by repetitive light touch, joint movement, or neuromuscular electrical stimulation (NMS). Only one of these six patients had a thalamic lesion. Quantitative sensory testing showed substantial impairment of pain and temperature sensation in all six patients, whereas light touch, vibration and position sense, and graphaesthesia were normal (three patients) or relatively spared (three patients). By contrast, none of 15 stroke patients in whom NMS did not evoke dysaesthesiae had clinical evidence of dissociated sensory loss. Conscious perception of joint movement and light touch is mediated mainly by the same population of large myelinated fibres activated preferentially by low intensity electrical stimulation. It is suggested that activation of these non-nociceptive, presumably dorsal column, afferents may contribute to dysaesthesiae in some patients with sensory loss after stroke.