Parietal and cingulate processes in central pain.: A combined positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) study of an unusual case
Parietal and cingulate processes in central pain.: A combined positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) study of an unusual case
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DOI：
10.1016/s0304-3959(99)00190-6
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发表时间：
2000-01-01
期刊：
影响因子：
7.4
通讯作者：
Laurent, B
中科院分区：
文献类型：
--
作者：
Peyron, R;García-Larrea, L;Laurent, B
顶叶、岛叶和前扣带回皮质参与了伤害性输入的处理和痛觉的产生。顶叶病变可能通过通常被认为涉及“内侧”疼痛系统(即丘脑内侧核和前扣带回(ACC))的机制产生中枢性疼痛。我们在此报告一位患者的正电子发射计算机断层扫描(PET)和功能磁共振成像(FMRI)数据，该患者在右侧顶叶皮质(SI和SII)和右侧ACC(Brodmann区24和32)同时受累后出现中枢性疼痛和左侧异位痛觉，从而质疑皮质疼痛处理的示意图。无论在基础状态(包括自发性疼痛和梗死灶周围持续低灌注区)，还是在左侧痛觉超常时，残余扣带回皮质的rCBF均未见增加。因此，正如先前在延髓外侧梗塞患者中观察到的那样，自发性疼痛或痛觉异常都不会复制正常受试者在伤害性疼痛后观察到的扣带回激活。相反，正电子发射计算机断层扫描和功能磁共振成像的数据都支持“侧向辨别”疼痛系统的可塑性改变。尤其是，痛觉异常与右侧脑岛/大脑皮质梗死区前方的活动增加有关。这种反应很可能是由非伤害性刺激在左侧引起的奇怪而非常令人不快的超速感觉的原因。(C)2000年国际疼痛研究协会。由Elsevier Science BV出版。
Parietal, insular and anterior cingulate cortices are involved in the processing of noxious inputs and genesis of pain sensation. Parietal lesions may generate central pain by mechanisms generally assumed to involve the 'medial' pain system (i.e. medial thalamic nuclei and anterior cingulate cortex (ACC)). We report here PET and fMRI data in a patient who developed central pain and allodynia in her left side after a bifocal infarct involving both the right parietal cortex (SI and SII) and the right ACC (Brodmann areas 24 and 32), thus questioning the schematic representation of cortical pain processing. No rCBF increase was found in any part of the residual cingulate cortices, neither in the basal state (which included spontaneous pain and extended hypoperfusion around the infarct), nor during left allodynic pain. Thus, as previously observed in patients with lateral medullary infarct, neither spontaneous pain nor allodynia reproduce the cingulate activation observed after noxious pain in normal subjects. Conversely, both PET and fMRI data argue in favour of plastic changes in the 'lateral discriminative' pain system. Particularly, allodynia was associated with increased activity anteriorly to the infarct in the right insula/SII cortex. This response is likely to be responsible for the strange and very unpleasant allodynic sensation elicited on the left side by a nonnoxious stimulation. (C) 2000 International Association for the Study of Pain. Published by Elsevier Science BV.