Complex regional pain syndrome (CRPS) type I in stroke patients is usually known to affect the hemiplegic upper limb. We report a case of CRPS presented in an ipsilesional arm of a 72-year-old female patient after an ischemic stroke at the left middle cerebral artery territory. Clinical signs such as painful range of motion and hyperalgesia of her left upper extremity, swollen left hand, and dystonic posture were suggestive of CRPS. A three-phase bone scintigraphy showed increased uptake in all phases in the ipsilesional arm. Diffusion tensor tractography showed significantly decreased fiber numbers of the corticospinal tract and the spinothalamic tract in both unaffected and affected hemispheres. Pain and range of motion of the left arm of the patient improved after oral steroids with a starting dose of 50 mg/day.
Aged ; Arm ; Complex Regional Pain Syndromes ; Diffusion ; Diffusion Tensor Imaging ; Female ; Hand ; Humans ; Hyperalgesia ; Middle Cerebral Artery ; Posture ; Pyramidal Tracts ; Radionuclide Imaging ; Range of Motion, Articular ; Spinothalamic Tracts ; Steroids ; Stroke ; Upper Extremity

Central pain, a neuropathic pain caused by an injury or dysfunction of the central nervous system, is a common, annoying sequela of mild traumatic brain injury (mTBI). Clarification of the pathogenetic mechanism of central pain is mandatory for precise diagnosis, proper management, and prognosis prediction. The introduction of diffusion tensor imaging allowed assessment of the association of the central pain and injury of the spinothalamic tract (STT), and traumatic axonal injury (TAI) in mTBI. In this review, 6 diffusion tensor tractography studies on central pain due to TAI of the STT in patients with mTBI are reviewed. The diagnostic approach for TAI of the STT in individual patients with mTBI is discussed, centering around the methods that these studies employed to demonstrate TAI of the STT.
Axons* ; Brain Concussion ; Brain Injuries* ; Central Nervous System ; Diagnosis ; Diffusion ; Diffusion Tensor Imaging ; Humans ; Neuralgia ; Prognosis ; Spinothalamic Tracts*

No abstract available.
Accidental Falls* ; Craniocerebral Trauma* ; Head* ; Spinothalamic Tracts*

No abstract available.
Accidental Falls* ; Craniocerebral Trauma* ; Head* ; Spinothalamic Tracts*

Spinal dorsal horn nociceptive neurons have been shown to undergo long-term synaptic plasticity, including long-term potentiation (LTP) and long-term depression (LTD). Here, we focused on the spinothalamic tract (STT) neurons that are the main nociceptive neurons projecting from the spinal cord to the thalamus. Optical technique using fluorescent dye has made it possible to identify the STT neurons in the spinal cord. Evoked fast mono-synaptic, excitatory postsynaptic currents (eEPSCs) were measured in the STT neurons. Time-based tetanic stimulation (TBS) was employed to induce long-term potentiation (LTP) in the STT neurons. Coincident stimulation of both pre- and postsynaptic neurons using TBS showed immediate and persistent increase in AMPA receptor-mediated EPSCs. LTP can also be induced by postsynaptic spiking together with pharmacological stimulation using chemical NMDA. TBS-induced LTP observed in STT neurons was blocked by internal BAPTA, or Ni2+, a T-type VOCC blocker. However, LTP was intact in the presence of L-type VOCC blocker. These results suggest that long-term plastic change of STT neurons requires NMDA receptor activation and postsynaptic calcium but is differentially sensitive to T-type VOCCs.
alpha-Amino-3-hydroxy-5-methyl-4-isoxazolepropionic Acid ; Animals ; Calcium ; Depression ; Egtazic Acid ; Excitatory Postsynaptic Potentials ; Horns ; Long-Term Potentiation* ; N-Methylaspartate ; Neurons* ; Nociceptors ; Plastics ; Rats* ; Spinal Cord* ; Spinothalamic Tracts* ; Thalamus

Cerebral lesions can cause dermatomal sensory deficit. The most commonly reported site is the medulla oblongata due to its well-separated sensory systems. Dermatomal sensory deficit that has developed after pontine infarctions have been reported in several cases, the majority of which involved the medial lemniscus. However, restricted spinothalamic sensory loss has rarely been reported in pontine infarctions. We report herein a patient who presented with dermatomal spinothalamic sensory deficits below the tenth thoracic level after pontine infarction.
Humans ; Infarction ; Medulla Oblongata ; Spinothalamic Tracts

In rare cases restricted sensory deficits along the somatotopic topography of the spinothalamic tract can develop from a lateral medullary infarction. To our knowledge, isolated dermatomal sensory deficit as a single manifestation of a lateral medullary infarction has not been reported previously. A 58-year-old man presenting with sudden left-sided paresthesia complained of sensory deficit of pain and temperature below the left T4 sensory level without other neurologic deficits. Diffuse- and T2-weighted magnetic resonance imaging (MRI) of the brain showed high signal intensities in the right lower medulla oblongata, whereas thoracic-spine MRI and somatosensory evoked potentials produced normal findings.
Brain ; Evoked Potentials, Somatosensory ; Humans ; Infarction* ; Magnetic Resonance Imaging ; Medulla Oblongata ; Middle Aged ; Neurologic Manifestations ; Paresthesia ; Spinothalamic Tracts

Loss of pain and temperature sensation due to lateral medullary infarction are well known and classically involve the ipsilateral side of the face and the lower part of the body on the controlateral side. This pattern of sensory loss below a certain level on the trunk, usually a sign of spinal cord disease, may also appear following a lesion in the lateral medullar, due to damage to the spinothalamic tract. A 72-year-old hypertensive man developed sudden dizziness, headache, and gait ataxia. On neurologic examination, he had left limb and gait ataxia. Five days later he noted loss of pain and temperature sensation on the right leg and trunk with a sensory level at T4 with preservation of touch, vibration, and joint position sense in all limbs. Brain MRI showed a small infarct in the left lower lateral medulla. Brain MR angiography showed stenosis of the right proximal carotid artery, left distal vertebral artery, and mid-basilar artery. We report a case of sensory defects with a sensory level on the trunk that occured as the result of lesion of the lower lateral medulla.
Aged ; Angiography ; Arteries ; Brain ; Carotid Arteries ; Constriction, Pathologic ; Dizziness ; Extremities ; Gait Ataxia ; Headache ; Humans ; Infarction ; Joints ; Leg ; Magnetic Resonance Imaging ; Medulla Oblongata ; Neurologic Examination ; Proprioception ; Sensation ; Spinal Cord Diseases ; Spinothalamic Tracts ; Vertebral Artery ; Vibration

OBJECTIVETo investigate the role of the dorsal column (DC) in the inhibitory effect of somatic afferent inputs on the central pressor response.

METHODSThe femoral arterial pressure, mean arterial pressure (MAP), electrocardiogram (ECG) and heart rate (HR) of the male SD rats were recorded when the hypothalamic paraventricular nucleus (PVN) was electrically stimulated with or without destruction of DC. The inhibitory effect of the deep peroneal nerve (DPN) on the pressor response induced by stimulation of PVN was observed 20 min or 5 d after ipsilateral DC destruction.

RESULTSStimulating DPN inhibited the pressor response elicited by electrical stimulation of PVN with an inhibitory rate of 43.29%. Twenty minutes after destroying the right DC, stimulation of the right or left DPN could inhibit the pressor response with an inhibitory rate of 38.64% and 39.97%, respectively (P>0.05); five days later the inhibitory rates remained as 33.87% and 36.86% respectively (P>0.05). The pain responses of both hindlimbs in the rats with the right DC destroyed showed no significant difference compared with the intact rats.

CONCLUSIONDC is not involved in the inhibitory effect of DPN on the pressor response induced by PVN stimulation.

Afferent Pathways ; physiology ; Animals ; Blood Pressure ; physiology ; Electric Stimulation ; Male ; Paraventricular Hypothalamic Nucleus ; physiology ; Peroneal Nerve ; physiology ; Pressoreceptors ; physiology ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Spinal Cord ; physiology ; Spinothalamic Tracts ; physiology

Pure sensory stroke (PSS), first described by Fisher in 1965, is a clinical condition characterized by numbness and paresthesia of the face, arm and trunk on one side, in absence of other neurologic deficit. PSS could arise anywhere along the sensory system from the cerebral cortex to the medulla. The authors experienced 5 patients with PSS: one patient had a hemorrhage on the thalamocortical pathway including the internal capsule and the corona radiata. Two another had thalarnic lesions. The fourth had a pontine hemorrhage with perioral onionpeel distributed face sensor- involvement. And the last had a pontine lacune involving crossed trigeminothalamic tract and lateral spinothalamic tract.
Arm ; Cerebral Cortex ; Hemorrhage ; Humans ; Hypesthesia ; Internal Capsule ; Neurologic Manifestations ; Paresthesia ; Spinothalamic Tracts ; Stroke*