Pure sensory syndromes and post-stroke pain secondary to bilateral thalamic lacunar infarcts: a case report

Journal of Medical Case Reports

Jan F Prytz²  Karl B Alstadhaug¹ 

[1] Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway;Department of Radiology, Nordland Hospital Trust, Nordland, Norway

关键词: Déjerine-Roussy syndrome;    Post-stroke pain;    Lacunar infarct;    Thalamus;    Sensory stroke;   

Others  :  1195328
DOI  :  10.1186/1752-1947-6-359

 received in 2012-06-01, accepted in 2012-09-25,  发布年份 2012

【 摘 要 】

Introduction

Patients often complain about sensory symptoms that appear to the doctor as harmless, and reassurances are often given. Sensory strokes may easily be ignored.

Case presentation

A 48-year-old Caucasian woman with insulin-dependent diabetes and hyperlipidemia experienced symptoms that progressed within hours to a complete left-sided hemisensory syndrome. This was caused by a lacunar infarct in the ventral posterior tier nuclei of the right thalamus. A few days later she gradually developed an almost identical, but incomplete hemisensory syndrome on the opposite side caused by a corresponding lacune in the left thalamus. Severe persistent and paroxysmal pain on both sides of the body became disabling.

Conclusion

Small strokes only affecting the somatosensory system should not be underestimated. Neuropathic pain may result. Probably unique in the present case is the demonstration of bilateral thalamic pain secondary to two almost identical thalamic infarcts. Small vessel disease (microatheroma or lipohyalinosis) was the most likely cause of the lacunes. One can only speculate if there was an occlusion in two separate thalamic perforators, or in a single dominant artery supplying the bilateral thalami.

【 授权许可】

   
2012 Alstadhaug and Prytz; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Fisher CM: Pure sensory stroke involving face, arm and leg. Neurology (Minneap) 1965, 15:76.
• [2]Kim JS: Pure sensory stroke. Clinical-radiological correlates of 21 cases. Stroke 1992, 23:983-987.
• [3]Fisher CM: Pure sensory stroke and allied conditions. Stroke 1982, 13:434.
• [4]Kim JH, Greenspan JD, Coghill RC, JD , Ohara S, Lenz FA: Lesions limited to the human thalamic principal sensory nucleus (ventral caudal) are associated with loss of cold sensations and central pain. J Neurosci 2007, 27:4995-5004.
• [5]Paciaroni M, Bogousslavsky J: Pure sensory syndromes in thalamic stroke. Eur Neurol 1998, 39:211-217.
• [6]Déjerine J, Roussy G: Le syndrome thalamique. Rev Neurol (Paris) 1906, 14:521-532.
• [7]Bennett MI, Attal N, Backonja MM, Baron R, Bouhassira D, Freynhagen R, Scholz J, Tölle TR, Wittchen HU, Jensen TS: Using screening tools to identify neuropathic pain. Pain 2007, 127:199-203.
• [8]MacGowan DJ, Janal MN, Clark WC, Wharton RN, Lazar RM, Sacco RL, Mohr JP: Central poststroke pain and Wallenberg’s lateral medullary infarction: frequency, character, and determinants in 63 patients. Neurology 1997, 49:120-155.
• [9]Martí-Vilalta JL, Arboix A, Mohr JP: Microangiopathies (Lacunes). In Stroke: Pathophysiology, Diagnosis, and Management. 5th edition. Edited by Mohr JP. Elsevier and Saunders, Philadelphia; 2011:494-497.
• [10]Smith AB, Smirniotopoulos JG, Rushing EJ, Goldstein SJ: Bilateral thalamic lesions. Am J Radiol 2009, 192:W53-W62.
• [11]Lazzaro NA, Wright B, Castillo M, Fischbein NJ, Glastonbury CM, Hildenbrand PG, Wiggins RH, Quigley EP, Osborn AG: Artery of percheron infarction: imaging patterns and clinical spectrum. Am J Neuroradiol 2010, 31:1283-1289.
• [12]Cordery RJ, Rossor MN: Bilateral thalamic pain secondary to bilateral thalamic infarcts relieved by a further unilateral ischaemic episode. Eur J Neurol 1999, 6:717-719.
• [13]Schmahmann JD: Vascular syndromes of the thalamus. Stroke 2003, 34:2264-2278.
• [14]Arboix A, García-Plata C, García-Eroles L, Massons J, Comes E, Oliveres M, Targa C: Clinical study of 99 patients with pure sensory stroke. J Neurol 2005, 252:156-162.
• [15]Arboix A, Font A, Garro C, García-Eroles L, Comes E, Massons J: Recurrent lacunar infarction following a previous lacunar stroke: a clinical study of 122 patients. J Neurol Neurosurg Psychiatry 2007, 78:1392-1394.
• [16]Klit H, Finnerup NB, Jensen TS: Central post-stroke pain: clinical characteristics, pathophysiology, and management. Lancet Neurol 2009, 8:857-868.
• [17]Dostrovsky JO: Role of thalamus in pain. Prog Brain Res 2000, 129:245-257.
• [18]Naidich TP, Duvernoy HM, Delman BN, Sorensen AG, Spyros SK, Haacke EM, Benner T, Boom WW, Cattin F, Choi PS: Duvernoy’s Atlas of the Human Brain Stem and Cerebellum. Springer, Wien; 2009.
• [19]Yamada K, Akazawa K, Yuen S, Goto M, Matsushima S, Takahata A, Nakagawa M, Mineura K, Nishimura T: MR imaging of ventral thalamic nuclei. Am J Neuroradiol 2010, 31:732-735.