In The Name of GOD Central Pain Syndrome HR Saeidi MD Associate Professor of NeurosurgeryKUMS Central Pain Syndrome Pain associated with lesions of the CNS
The clinical picture is similar regardless if the pts suffered a massive injury/stroke or a minor one The common feature is a steady, constant, burning, dysesthetic, or achy pain
Content outline Cord central pain Brain central pain Post stroke Thalamic Spinal Stenosis MS, Parkinsons, Misc Theories of pathogenesis
Spinothalamic injury Pathways that carry pain & temperature sensations Most accepted theory Lemniscal injury & release of the spinothalamic system Less recognized Neurologic abnormalities
Numbness incomplete Sensory abnormalities variable Abnormality of superficial touch, temperature & pain Decreased sensory position sense Spontaneous & evoked pain Abnormalities in gait (sensory ataxia) Cord Central Pain Essentially a young mans disease Reported incidence is 6% to 94% Etiology and level or completeness of lesions did not
correlate with presence, severity, or quality of pain Cord Central Pain Etiology Trauma number one cause Cord infarction AVM Neoplasm Iatrogenic Inflammatory
Congenital Cord Central Pain Onset of symptoms may be delayed after the causative event The longer the delay in pain onset, the more likely that a syrinx is present Syrinx must be identified & treated to prevent ND
Cord Central Pain Spontaneous steady pain Spontaneous neuralgic pain 1/2 of patients have severe pain Steady & neuralgic components predominate Brain Central pain Results from HI Stroke: most common AVMs
Neoplasm MS Syringobulbia Abscesses Brain Central Pain Brainstem lesions Most common vascular cause of pain is Wallenbergs synd (lateral medullary synd) Brain lesions
Dejerine-Roussy synd(thalamic pain synd) Brain Central Pain Steady & evoked pain predominate HI & craniotomy rarely result in central pain Onset may be immediate or delayed Medical treatment
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