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Central post-stroke pain

Other Names for this Disease
  • Central pain syndrome
  • Dejerine Roussy syndrome
  • Posterior thalamic syndrome
  • Retrolenticular syndrome
  • Thalamic hyperesthetic anesthesia
More Names
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Tests & Diagnosis

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How is central post-stroke pain diagnosed?

In a review article from 2009 in the journal Lancet Neurology, the authors discuss making a diagnosis of central post-stroke pain (CPSP). They recognize that a definite diagnosis of central post-stroke pain (CPSP) may be difficult, mainly because of the variable signs and symptoms, the frequent concurrence of several pain types, and the lack of clear diagnostic criteria for CPSP. The diagnosis may be based on a combination of the history, a clinical and sensory examination, imaging of lesions (such as CT or MRI), and other examinations. The history of stroke may be confirmed by imaging (either CT or MRI) to visualize the cause (type, location, and size) and to rule out other central causes of the pain. Details about the pain, including when and how the pain began; pain quality; and the presence of dysesthesia (impaired sensitivity) or allodynia (pain resulting from something that should not normally cause pain) are helpful in the diagnosis. Sometimes patients are asked to indicate the area of pain on a drawing of the body (a pain drawing). The clinical examination may include sensory testing to confirm and pinpoint the presence of sensory abnormalities, but also to rule out other causes of pain.[1]

Experts have proposed that mandatory criteria for the diagnosis of CPSP include:
  • Pain within an area of the body corresponding to the abnormality of the CNS
  • History suggestive of a stroke and onset of pain at or after stroke onset
  • Confirmation of a CNS lesion by imaging, or negative or positive sensory signs confined to the area of the body corresponding to the lesion
  • Other causes of pain are excluded or considered highly unlikely

Supportive criteria may include:

  • No primary relation to movement, inflammation, or other local tissue damage
  • Descriptions such as burning, painful cold, electric shocks, aching, pressing, stinging, and pins and needles, although all pain descriptions may apply
  • Allodynia or dysesthesia to touch or cold[1]
Last updated: 5/25/2011

  1. Henriette Klit, Nanna B Finnerup, Troels S Jensen. Central post-stroke pain: clinical characteristics, pathophysiology, and management. Lancet Neurology. 2009; 8:859-868.