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Title: Dissecting neuropathic from poststroke pain: the white matter within
Authors: LEMOS, Marcelo DelboniFAILLENOT, IsabelleLUCATO, Leandro TavaresTEIXEIRA, Manoel JacobsenBARBOSA, Luciana MendoncaALHO, Eduardo Joaquim LopesCONFORTO, Adriana BastosRODRIGUES, Antonia Lilian de LimaGALHARDONI, RicardoSILVA, Valquiria Aparecida daLISTIK, ClariceROSI, JeffersonPEYRON, RolandGARCIA-LARREA, LuisANDRADE, Daniel Ciampi de
Citation: PAIN, v.163, n.4, p.765-778, 2022
Abstract: Poststroke pain (PSP) is a heterogeneous term encompassing both central neuropathic (ie, central poststroke pain [CPSP]) and nonneuropathic poststroke pain (CNNP) syndromes. Central poststroke pain is classically related to damage in the lateral brainstem, posterior thalamus, and parietoinsular areas, whereas the role of white matter connecting these structures is frequently ignored. In addition, the relationship between stroke topography and CNNP is not completely understood. In this study, we address these issues comparing stroke location in a CPSP group of 35 patients with 2 control groups: 27 patients with CNNP and 27 patients with stroke without pain. Brain MRI images were analyzed by 2 complementary approaches: an exploratory analysis using voxel-wise lesion symptom mapping, to detect significant voxels damaged in CPSP across the whole brain, and a hypothesis-driven, region of interest-based analysis, to replicate previously reported sites involved in CPSP. Odds ratio maps were also calculated to demonstrate the risk for CPSP in each damaged voxel. Our exploratory analysis showed that, besides known thalamic and parietoinsular areas, significant voxels carrying a high risk for CPSP were located in the white matter encompassing thalamoinsular connections (one-tailed threshold Z > 3.96, corrected P value <0.05, odds ratio = 39.7). These results show that the interruption of thalamocortical white matter connections is an important component of CPSP, which is in contrast with findings from nonneuropathic PSP and from strokes without pain. These data can aid in the selection of patients at risk to develop CPSP who could be candidates to pre-emptive or therapeutic interventions.
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Artigos e Materiais de Revistas Científicas - FM/MNE
Departamento de Neurologia - FM/MNE

Artigos e Materiais de Revistas Científicas - HC/ICHC
Instituto Central - HC/ICHC

Artigos e Materiais de Revistas Científicas - HC/InRad
Instituto de Radiologia - HC/InRad

Artigos e Materiais de Revistas Científicas - HC/IPq
Instituto de Psiquiatria - HC/IPq

Artigos e Materiais de Revistas Científicas - LIM/15
LIM/15 - Laboratório de Investigação em Neurologia

Artigos e Materiais de Revistas Científicas - LIM/44
LIM/44 - Laboratório de Ressonância Magnética em Neurorradiologia

Artigos e Materiais de Revistas Científicas - LIM/62
LIM/62 - Laboratório de Fisiopatologia Cirúrgica

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