Abstract
Objective: Describe an atypical case of ipsilateral Dejerine-Roussy syndrome(DRS) after an ischemic stroke.
Background: Post-stroke thalamic pain was first described in 1906 by Joseph Dejerine and Gustave Roussy. Allodynia and tingling are the most frequent symptoms described. Anatomically, sensory signals originating in the peripheral nervous system decussate in different areas of the midbrain and spinal cord(SC) to reach the somatosensory cortex, causing contralateral symptoms. However, a small number of cases of ipsilateral findings have been described.
Design/Methods: Case Report
Results: 67 year old female with history of hypertension and diabetes presented with new-onset severe left lower extremity burning pain and tingling, associated with right-sided facial droop. Allodynia and hyperesthesia in the left lower extremity was noted on exam. Blood tests were unremarkable. CT head revealed a hazy decreased attenuation overlying the left thalamus, and brain MRI confirmed an acute infarct within the left thalamus. The presence of this thalamic stroke in the context of the patient’s unilateral extremity pain suggested the diagnosis of DRS. The patient received conventional analgesic treatment with no improvement. She was started on aspirin and atorvastatin, with gabapentin for neuropathic pain. Pain decreased mildly and she was transferred to an inpatient rehabilitation unit.
Conclusions: DRS is typically associated with contralateral neuropathic pain. However, few cases of thalamic strokes leading to ipsilateral symptomatology have been reported. The exact underlying mechanism of this atypical presentation remains unclear; however, studies in other neurologic disorders causing ipsilateral symptoms have suggested a few potential theories. These theories include: (1)neuroplastic reorganization of thalamic microstructure altering the distribution of neural pathways; (2)non-decussation of neural tracts; or (3)accessory ipsilateral descending tracts with bilateral operating systems:80–90% of cortico-spinal fibers decussate along the midbrain-medullary levels, however, remaining corticospinal fibers can travel to ipsilateral ventral aspect of the SC. Conventional treatment with neuroleptic medications is the first line to achieve pain control.
Disclosure: Dr. Saleh Velez has nothing to disclose. Dr. Venkataraman has nothing to disclose. Dr. Mariuma has nothing to disclose.
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