Korean J Pain.  2016 Apr;29(2):119-122. 10.3344/kjp.2016.29.2.119.

Thalamic Pain Misdiagnosed as Cervical Disc Herniation

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea.
  • 2Department of Anesthesiology and Pain Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea. uk201@hanmail.net

Abstract

Thalamic pain is a primary cause of central post-stroke pain (CPSP). Clinical symptoms vary depending on the location of the infarction and frequently accompany several pain symptoms. Therefore, correct diagnosis and proper examination are not easy. We report a case of CPSP due to a left acute thalamic infarction with central disc protrusion at C5-6. A 45-year-old-male patient experiencing a tingling sensation in his right arm was referred to our pain clinic under the diagnosis of cervical disc herniation. This patient also complained of right cramp-like abdominal pain. After further evaluations, he was diagnosed with an acute thalamic infarction. Therefore detailed history taking should be performed and examiners should always be aware of other symptoms that could suggest a more dangerous disease.

Keyword

Central post-stroke pain; Cervical disc herniation; Cramp-like abdominal pain; Differential diagnosis; Thalamic infarction; Thalamic pain

MeSH Terms

Abdominal Pain
Arm
Diagnosis
Diagnosis, Differential
Humans
Infarction
Pain Clinics
Sensation

Figure

  • Fig. 1 Coronal plane of cervical spine computed tomography (CT) showing a mild uncovertebral hypertrophy at right side of C3-4 (A). Posterior spurs at C5-6 is shown on bone window setting of axial plane of cervical spine (B) and central protrusion at C5-6 is shown on soft tissue window setting of same image as well (C).

  • Fig. 2 Magnetic resonance (MR) diffusion image shows acute infarction at left thalamus. The lesion is on the posterolateral area of left thalamus. (A) is b1000 DWI. (B) is ADC map which shows the lesion along the arrow. The lesion is shown on T2WI (C) and T2FLAIR (D) as high signal. TOF-MR angiography shows no remarkable finding in intracranial major vessels.


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