Brain Infarction (Thalamus and Brainstem)

Central post-stroke pain (CPSP) is a central neuropathic pain condition resulting from lesions of a prior cerebrovascular accident (CVA) mainly affecting the spinothalamocortical tract. About 5%–10% of patients with CVAs develop CPSP. The pain is thought to be secondary to a complex interaction of central disinhibition, central sensitization, and an imbalance of stimuli, although the exact mechanism remains unknown. The pain is located within and associated with sensory dysfunction in a region affected by a prior CVA lesion. The pain is often described as burning, stabbing, and sharp. Allodynia, hyperalgesia, and evoked dysesthesia appear to be major clinical findings for this condition. There are no specific diagnostic criteria for CPSP, and treatment is often difficult. Medications such as tricyclic antidepressants and anticonvulsants are often used. Motor cortex stimulation and deep brain stimulation are active areas of research and offer hope that additional treatment modalities may be identified.