Pain sensitivity alterations as a function of lesion location in the parasylvian cortex
Pain sensitivity alterations as a function of lesion location in the parasylvian cortex
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DOI：
10.1016/s0304-3959(99)00021-4
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发表时间：
1999-06-01
期刊：
影响因子：
7.4
通讯作者：
Lenz, FA
中科院分区：
文献类型：
--
作者：
Greenspan, JD;Lee, RR;Lenz, FA
使用接触热（所有6例）和引起针刺痛的尖锐探针（4/6）评价了6例累及侧裂旁大脑皮质病变的患者的痛阈值。在不了解个体感觉状态的情况下，两位作者评估了这些患者的MRI，并确定了以下大脑区域在病变中的参与程度：前额叶、后额叶、后额叶和顶叶盖。每个病人的病变至少包括两个这些地区。三个人表现出显着的偏侧差异疼痛的敏感性，与他/她的病变对侧的手阈值升高。这些病例的共同特征是包括顶骨盖和后顶骨。其他三例病例没有显示出异常疼痛阈值的证据。这些病例的共同特点是顶骨盖明显保留。因此，这一系列的病例指出顶骨盖的意义，无论是单独的或与相邻的后穹窿，正常的疼痛阈值。相比之下，在两个病例中，广泛累及前额叶与异常痛阈无关。6名患者中有4名还接受了冷痛耐受性试验，该试验可能涉及比阈值试验更多的疼痛情感/动机方面。这些患者中只有2例对侧比同侧表现出更大的耐受性，并且他们的病变是4例中累及大部分小脑的2例。这一结果支持了这一理论，即在伤害性加工的神经元的参与有关的情感/动机方面的疼痛。(C)1999年国际疼痛研究协会。出版社：Elsevier Science B. V.
Six patients with lesions involving parasylvian cerebral cortex were evaluated for their pain thresholds using contact heat (all six) and sharp probes that evoke pin-prick pain (4/6). Without knowledge of the sensory status of the individuals, two of the authors evaluated the MRIs of these patients, and determined to what extent the following cerebral regions were involved in the lesion: anterior insula, posterior insula, retroinsula, and parietal operculum. Each patient's lesion encompassed at least two of these regions. Three individuals demonstrated significant laterality differences in pain sensitivity, with elevated thresholds on the hand contralateral to his/her lesion. The common feature in these cases was the inclusion of the parietal operculum and posterior insula. The three other cases showed no evidence of abnormal pain thresholds. The common feature of these cases was the apparent sparing of the parietal operculum. Thus, this series of cases points to the significance of the parietal operculum, either alone or with adjacent posterior insula, for normal pain thresholds. In comparison, extensive involvement of the anterior insula in two cases was not associated with abnormal pain thresholds. Four of the six patients were also evaluated with a cold pain tolerance test, which presumably involves more affective/motivational aspects of pain than threshold tests. Only two of these patients showed greater tolerance contralaterally versus ipsilaterally, and theirs were the two lesions of the four with involvement of a large part of the insula. This result supports the theory that the insula's involvement in nociceptive processing is related to the affective/motivational aspect of pain. (C) 1999 International Association for the Study of Pain. Published by Elsevier Science B.V.