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Open Access Highly Accessed Case report

Pure sensory syndromes and post-stroke pain secondary to bilateral thalamic lacunar infarcts: a case report

Karl B Alstadhaug13* and Jan F Prytz2

Author Affiliations

1 Department of Neurology, Nordland Hospital Trust, Bodø 8092, Norway

2 Department of Radiology, Nordland Hospital Trust, Nordland, Norway

3 Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway

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Journal of Medical Case Reports 2012, 6:359  doi:10.1186/1752-1947-6-359

Published: 24 October 2012

Abstract

Introduction

Patients often complain about sensory symptoms that appear to the doctor as harmless, and reassurances are often given. Sensory strokes may easily be ignored.

Case presentation

A 48-year-old Caucasian woman with insulin-dependent diabetes and hyperlipidemia experienced symptoms that progressed within hours to a complete left-sided hemisensory syndrome. This was caused by a lacunar infarct in the ventral posterior tier nuclei of the right thalamus. A few days later she gradually developed an almost identical, but incomplete hemisensory syndrome on the opposite side caused by a corresponding lacune in the left thalamus. Severe persistent and paroxysmal pain on both sides of the body became disabling.

Conclusion

Small strokes only affecting the somatosensory system should not be underestimated. Neuropathic pain may result. Probably unique in the present case is the demonstration of bilateral thalamic pain secondary to two almost identical thalamic infarcts. Small vessel disease (microatheroma or lipohyalinosis) was the most likely cause of the lacunes. One can only speculate if there was an occlusion in two separate thalamic perforators, or in a single dominant artery supplying the bilateral thalami.

Keywords:
Sensory stroke; Thalamus; Lacunar infarct; Post-stroke pain; Déjerine-Roussy syndrome