Functional magnetic resonance imaging and diffusion tensor imaging in a case of central poststroke pain

The role of the lesion location within functional pain systems is not fully understood for central poststroke pain (CPSP) pathogenesis. In a patient with CPSP we used data from both functional magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) for anatomo-functional correlations. Structural MRI showed a small residual cavity confined to the right thalamic ventral posterolateral nucleus and the adjacent posterior arm of the internal capsule. DTI maps showed selective reduction of right sensory thalamocortical fibers. Functional MRI, performed with different thermonociceptive stimuli, showed pain-specific signal changes in the anterior cingulate gyrus (BA 24/32) and in the associative parietal regions (BA 5/7). These findings underline, for CPSP pathogenesis, the role of damage of lateral nociceptive thalamoparietal fibers together with the release of activity of anterior cingulate and posterior parietal regions. Perspective: in a patient with CPSP, we combined noninvasive neuroimaging techniques (functional and diffusion MRI) to assess the anatomo-functional relationship in CPSP. Our investigations show, for CPSP pathogenesis, the role of damage of lateral nociceptive thalamoparietal fibers together with the release of activity of anterior cingulate and posterior parietal regions. (c) 2005 by the American Pain Society.