Contributions of neuroimaging in central poststroke pain: a review

Abstract

Background Central neuropathic poststroke pain (CNPSP) affects up to 12% of patients with stroke in general and up to 18% of patients with sensory deficits. This pain syndrome is often incapacitating and refractory to treatment. Brain computed tomography and magnetic resonance imaging (MRI) are widely used methods in the evaluation of CNPSP.

Objective The present study aims to review the role of neuroimaging methods in CNPSP.

Methods We performed a literature review of the main clinical aspects of CNPSP and the contribution of neuroimaging methods to study its pathophysiology, commonly damaged brain sites, and possible differential diagnoses. Lastly, we briefly mention how neuroimaging can contribute to the non-pharmacological CNPSP treatment. Additionally, we used a series of MRI from our institution to illustrate this review.

Results Imaging has been used to explain CNPSP pathogenesis based on spinothalamic pathway damage and connectome dysfunction. Imaging locations associated with CNPSP include the brainstem (mainly the dorsolateral medulla), thalamus (especially the ventral posterolateral/ventral posteromedial nuclei), cortical areas such as the posterior insula and the parietal operculum, and, more recently, the thalamocortical white matter in the posterior limb of the internal capsule. Imaging also brings the prospect of helping search for new targets for non-pharmacological treatments for CNPSP. Other neuropathic pain causes identified by imaging include syringomyelia, multiple sclerosis, and herniated intervertebral disc.

Conclusion Imaging is a valuable tool in the complimentary evaluation of CNPSP patients in clinical and research scenarios.

Resumo

Antecedentes A dor neuropática central pós-acidente vascular cerebral (DNPAVC) afeta até 12% dos pacientes com AVC em geral e até 18% dos pacientes com déficits sensoriais. Essa síndrome dolorosa costuma ser incapacitante e refratária ao tratamento. A tomografia computadorizada e a ressonância magnética do cérebro são métodos amplamente utilizados na avaliação da DNPAVC.

Objetivo Este estudo tem como objetivo revisar o papel dos métodos de neuroimagem na DNPAVC.

Métodos Realizamos uma revisão da literatura sobre os principais aspectos clínicos da DNPAVC e a contribuição dos métodos de neuroimagem para estudar a fisiopatologia da DNPAVC, locais cerebrais comumente lesados na DNPAVC e possíveis diagnósticos diferenciais. Por fim, mencionamos brevemente como a neuroimagem pode contribuir no tratamento não farmacológico da DNPAVC. Além disso, utilizamos uma série de imagens de ressonância magnética da nossa instituição para ilustrar esta revisão.

Resultados Os exames de imagem têm sido usados para explicar a patogênese da DNPAVC com base no dano da via espinotalâmica e na disfunção do conectoma. Os locais de imagem associados à DNPAVC incluem o tronco cerebral (principalmente o bulbo dorsolateral), o tálamo (especialmente os núcleos ventral posterolateral/ventral posteromedial), áreas corticais como a ínsula posterior e o opérculo parietal e, mais recentemente, a substância branca tálamo-cortical no membro posterior da cápsula interna. Os exames de imagem também trazem a perspectiva de auxiliar na busca de novos alvos para tratamentos não farmacológicos para DNPAVC. Outras causas de dor neuropática identificadas por exames de imagem incluem siringomielia, esclerose múltipla e hérnia de disco intervertebral.

Conclusão Os exames de imagem são uma ferramenta valiosa na avaliação complementar de pacientes com DNPAVC em cenários clínicos e de pesquisa.

Keywords

Neuralgia - Chronic Pain - Stroke - Neuroimaging - Magnetic Resonance Imaging

Palavras-chave

Neuralgia - Dor Crônica - Acidente Vascular Cerebral - Neuroimagem - Imageamento por Ressonância Magnética

Editor-in-Chief

Ayrton Roberto Massaro.

Associate Editor

Antonio José da Rocha.

Authors' Contributions

MDL: conceptualization, data curation, formal analysis, methodology, resources, validation, visualization, writing – original draft, and writing – review & editing; LMB: conceptualization, formal analysis, writing – original draft, and writing – review & editing; DCA: conceptualization, formal analysis, investigation, methodology, project administration, resources, supervision, visualization, writing – original draft, and writing – review & editing; LTL: conceptualization, data curation, formal analysis, funding acquisition, investigation, methodology, project administration, resources, supervision, validation, writing – original draft, and writing – review & editing.

Publikationsverlauf

Eingereicht: 06. März 2024

Angenommen: 09. Juni 2024

Artikel online veröffentlicht:
31. August 2024

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