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Poststroke Pain Syndrome/Central Pain Syndrome Updated 4/2010

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BASICS

  • Description
  • Epidemiology
  • Risk Factors
  • Pathophysiology
  • Etiology
  • General Prevention
  • Associated Conditions

DIAGNOSIS

  • Signs and Symptoms
  • Tests
  • Differential Diagnosis
  • Medication (Drugs)
  • Rehabilitation
  • Mental Health/Behavioral
  • Surgery

Follow-up

  • Prognosis
The following is an excerpt....
BASICS
Description

Resistant neuropathic pain occurs following injury to brain or spinal cord.

Epidemiology
Incidence
  • Wide range of incidence (7% to 94%) after spinal cord injury; more frequent after higher injuries
  • 1% to 5% following stroke, especially thalamic stroke
Risk Factors

No specific factors, aside from underlying injury states

Pathophysiology
  • The pathophysiology of central pain is unclear.
  • It is presumed that the sensation of pain is maintained in higher cortical structures, because attempts to treat central pain through distal neuroablative procedures are not effective.
  • Central pain may result from the global disinhibition of nociceptive pathways within the brain and spinal cord.
  • Pain severity or character does not correlate with the magnitude or location of the central nervous system injury.
Etiology ...

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FIG. 10.23. Intracranial manifestations of head injury. A: Note the hypodense subdural hematoma (arrows). There is ipsilateral compression of the ventricles and contralateral midline shift. B: Epidural bleed (arrows) with some soft-tissue swelling of the scalp.Credit: From Swischuk LE. Emergency Imaging of the Acutely Ill or Injured Child 3rd, Edition. Philadelphia: Lippincott Williams & Wilkins, 1994.