CENTRAL POST-STROKE PAIN - NEUROLOGICAL SYMPTOMS AND PAIN CHARACTERISTICS
CENTRAL POST-STROKE PAIN - NEUROLOGICAL SYMPTOMS AND PAIN CHARACTERISTICS
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DOI：
10.1016/0304-3959(89)90107-3
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发表时间：
1989-01-01
期刊：
影响因子：
7.4
通讯作者：
JOHANSSON, I
中科院分区：
文献类型：
--
作者：
LEIJON, G;BOIVIE, J;JOHANSSON, I
本研究的目的是描述中枢性卒中后疼痛（CPSP）患者的脑血管病变（CVL）的类型和位置、疼痛的特征以及除疼痛外的神经系统症状和体征。20名男性和7名女性，平均年龄为67岁，平均疼痛持续时间为44个月，在中风后9-188（平均53）个月进行了检查。临床症状、体征及CT检查显示，CVL位于脑干下部8例，累及丘脑9例，位于丘脑外侧及上级6例。其余4例患者的CVL位置无法确定。3例血肿均位于丘脑。4例患者疼痛立即发作，10例患者在卒中后第一个月内发作，其余患者延迟1-34个月。左侧疼痛18例。20例患者出现偏侧疼痛。大多数患者经历了一种以上的疼痛。最常见的性质是烧灼感、疼痛、刺痛和撕裂感，根据CVL的位置，频率存在一些差异。烧灼痛是最常见的，除了丘脑CVL患者，其中撕裂痛更常见。疼痛和刺痛也很常见。所有患者都认为疼痛是一个巨大的负担，大多数患者在视觉模拟量表上将疼痛强度评定为高。外界刺激增加了强度，最常见的是关节运动，冷和轻触。5名患者报告情绪刺激加重。除疼痛外，所有患者共同的唯一神经系统症状是温度敏感性降低，如定量方法所示。可能所有患者的疼痛敏感性也异常。88%的患者对皮肤刺激过敏，包括诱发性感觉迟钝，而触摸和振动的检测阈值分别仅为52%和41%。同样，发现轻瘫和共济失调的数字较低，分别为48%和62%。结论：只有少数脑卒中后中枢性疼痛患者有丘脑病变。因此，术语丘脑疼痛在大多数CPSP病例中是不准确的。症状和体征表明，CPSP的发展的关键因素是一个病变影响的脊髓丘脑皮质途径重要的温度和疼痛的敏感性。沿着神经轴沿着的病变水平对于疼痛的发生不是关键的，但是决定了相关神经症状的性质并且似乎影响疼痛的特征。
The intention of the present study was to characterize patients with central post-stroke pain (CPSP) with regard to type and location of the cerebrovascular lesion (CVL), the characteristics of the pain and the neurological symptoms and signs in addition to the pain. Twenty men and 7 women with a mean age of 67 years and a mean pain duration of 44 months were examined 9-188 (mean 53) months after their stroke. The clinical symptoms and signs and the CT scans indicated that the CVL were located in the lower brain-stem in 8 patients, involved the thalamus in 9 patients and were located lateral and superior to the thalamus in 6 patients. In the remaining 4 patients the location of the CVL could not be determined with certainty. The 3 identified hematomata were all located in the thalamus. The onset of the pain was immediate in 4 patients, within the first post-stroke months in 10 patients and delayed by 1-34 months in the rest. The pain was on the left side in 18 patients. Twenty patients had hemipain. Most patients experienced more than one type of pain. The most common qualities were burning, aching, pricking and lacerating, with some differences in the frequencies according to the location of the CVL. Burning pain was most common, except among the patients with thalamic CVL, in whom lacerating pain was more common. Aching and pricking pain were also frequent. All patients considered the pain to be a great burden and most rated the pain intensity as high on a visual analogue scale. The intensity was increased by external stimuli, the most common being joint movements, cold and light touch. Five patients reported aggravation by emotional stimuli. Besides pain, the only neurological symptom common to all patients was decreased temperature sensibility, as shown by quantitative methods. It is possible that pain sensibility was also abnormal in all. Hypersensitivities to cutaneous stimuli, including evoked dysesthesias were found in 88% of the patients, while the detection thresholds for touch and vibration were abnormal in only 52% and 41%, respectively. Similarly, low figures were found for paresis and ataxia, which were present in 48% and 62%, respectively. It is concluded that only a minority of patients with central pain after stroke have thalamic lesions. The term thalamic pain is therefore inaccurate in most cases of CPSP. The symptoms and signs indicate that the crucial factor for the development of CPSP is a lesion affecting the spino-thalamo-cortical pathway important for temperature and pain sensibility. The level of the lesion along the neuroaxis is not critical for occurrence of the pain, but decides the nature of the associated neurological symptoms and appears to affect the features of the pain.