Thalamic sensory strokes with and without pain: differences in lesion patterns in the ventral posterior thalamus
- Thomas Krause1,2,
- Peter Brunecker1,
- Sandra Pittl1,
- Birol Taskin2,3,
- Dinah Laubisch1,
- Benjamin Winter1,2,
- Malamati Eleni Lentza1,
- Uwe Malzahn4,
- Kersten Villringer1,
- Arno Villringer2,3,
- Gerhard J Jungehulsing1,2
- 1Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- 2Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- 3Department of Neurology, Max-Planck-Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- 4Institute of Clinical Epidemiology and Biometry, University of Würzburg, Berlin, Germany
- Correspondence to Dr T Krause, Charité-Universitätsmedizin Berlin, Department of Neurology and Centre for Stroke Research Berlin, Hindenburgdamm 30, 12200 Berlin, Germany;
Contributors TK, SP, GJJ, DL, MEL, KV and BW participated in the collection of the data. All authors contributed to the interpretation of the data. PB and UM led the statistical data analysis. PB wrote the customised software for supposition of the MRI data onto a thalamic atlas. TK and GJJ wrote the first draft of the manuscript, with detailed helpful comments from BT, AV and KV. All authors gave approval of the manuscript.
- Received 30 November 2011
- Revised 23 April 2012
- Accepted 28 April 2012
- Published Online First 13 June 2012
Objective Vascular lesions of the posterolateral thalamus typically result in a somatosensory syndrome in which some patients develop central neuropathic post-stroke pain (CPSP). Damage to the spinothalamic tract terminus is assumed to be a prerequisite for thalamic CPSP. At the nuclear level, it remains a matter of debate whether the ventral posterolateral nucleus (VPL) or the posterior portion of the ventral medial nucleus (VMpo) constitutes the decisive lesion site. The hypothesis of the study was that lesion location in thalamic CPSP patients differs from that in thalamic stroke patients without pain, and the aim was to identify whether this difference comprises the VPL and/or the VMpo.
Design 30 patients with chronic thalamic stroke and a persistent contralateral somatosensory syndrome were examined. CPSP patients (n=18) were compared with non-pain control patients. By coregistration of a digitised thalamic atlas with T1 weighted MR images, lesion clusters were allocated to the thalamic nuclei.
Results VPL was affected in both groups, but CPSP lesion clusters comprised the more posterior, inferior and lateral parts of the VPL compared with controls. Additional partial involvement of the VMpo was seen in only three pain patients. In three other pain patients, lesions involved neither the VPL nor the VMpo, but mainly affected the anterior pulvinar.
Conclusion This study specifies the role of the VPL in thalamic CPSP and shows that the posterolateratal and inferior parts in particular are critically lesioned in pain patients. In this thalamic subregion, afferents of the spinothalamic tract are known to terminate. In contrast, the data do not support a pivotal impact of the VMpo on thalamic CPSP.
Funding The project has received funding from the German Federal Ministry of Education and Research (BMBF) via the grant Centre for Stroke Research Berlin (01 EO 0801) and as part of the Competence Net Stroke (01GI9902/4).
Competing interests None.
Ethics approval Ethics approval was provided by the local ethics committee, Charité-Universitätsmedizin Berlin.
Provenance and peer review Not commissioned; externally peer reviewed.