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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We present a right-hemispheric stroke patient with complex regional pain syndrome (CRPS). The regional cerebral blow flow (rCBF) as determined using single photon emission computed tomography (SPECT) showed contralateral increase of tracer uptake in the left thalamus accompanied by crossed cerebellar diaschisis (CCD) in the left cerebellum. After rehabilitation, the CRPS in the right upper extremity recovered, although hemiplegia persisted on the left limbs. The rCBF determined a second time using SPECT showed that uptake was normal in the bilateral thalami, basal ganglia and bilateral cerebella. At a 6-month follow-up, the CRPS had not recurred. Our findings show that analysis of rCBF by SPECT is useful for the clinical evaluation and follow-up of CRPS. To the best of our knowledge, this is the first reported case with this particular pattern of symptoms amd symptom resolution.
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PMID:Cerebellar diaschisis and contralateral thalamus hyperperfusion in a stroke patient with complex regional pain syndrome. 1870 87

The objective of this study was to assess the possible causes of hemiplegic shoulder pain (HSP) in Turkish patients with stroke, to identify the correlation between HSP and clinical factors, and to review the effects of HSP on functional outcomes. A total of 187 consecutive patients with stroke were evaluated for the presence of HSP and for the possible causes. Each patient was evaluated by clinical, radiographic, and ultrasonographic examination. Daily living activities were assessed using the Functional Independence Measure at admission and at discharge. Patients were divided into two groups, one comprising patients with shoulder pain and the other comprising patients without shoulder pain. They were then compared with respect to clinical characteristics, radiologic findings, and Functional Independence Measure scores. Shoulder pain was present in 114 (61%) patients. Of the 114 patients with pain, 71 patients showed various grades of glenohumeral joint subluxation, 70 patients had complex regional pain syndrome-type I, 70 patients had impingement syndrome, 68 patients had spasticity, 49 patients had adhesive capsulitis, and 10 patients had thalamic pain. No correlation was found between shoulder pain and clinical factors (sex, hemiplegic side, hand dominance, etiologic cause, comorbidities). The relationship between shoulder pain and adhesive capsulitis was significant (P=0.01) and also complex regional pain syndrome-type I was statistically significant (P=0.001). The group without HSP showed significantly more improvement than the group with HSP in functional outcomes (P=0.01) and the hospitalization period was significantly shorter (P=0.03). Shoulder pain is a frequent problem in patients with stroke. It is, however, often difficult to isolate a specific cause and it causes a prolonged hospitalization period and can have a negative effect on functional outcomes.
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PMID:Poststroke shoulder pain in Turkish stroke patients: relationship with clinical factors and functional outcomes. 1907 23

In patients with phantom limb pain or complex regional pain syndrome (CRPS), sensory discrimination training increases tactile acuity, normalises cortical reorganisation and decreases pain. In healthy people, sensory cortical response, and tactile acuity, are greater if the participant looks towards the body part being stimulated. Does this effect enhance tactile training in CRPS patients? Ten patients underwent a 30-min tactile discrimination training session under four conditions (order randomised) in a 2 x 2 design: looking towards or away from the stimulated limb and seeing or not seeing skin. Tactile training imparted long-term improvement in tactile acuity when patients watched the reflected image of their unaffected limb in a mirror during training (that is, they looked towards the stimulated body part and could see the skin of the opposite body part in the mirror): two-point discrimination threshold (TPD) was 8mm less 2 days after training than it was before training ([95% CI=1.5-14.3mm], p<0.001). Although this condition also imparted a greater reduction in resting pain at post-treatment than the other conditions, and change in pain and change in TPD over the session were strongly related (r=0.83, p<0.001), there was no residual effect on pain at 2-day follow-up. In the other conditions, tactile acuity had returned to pre-training levels at 2-day follow-up. The results should directly improve management of CRPS, and have implications for rehabilitation of other conditions associated with nervous system injury or disease, for example stroke, in which tactile recovery is a major objective of rehabilitation.
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PMID:The effect of tactile discrimination training is enhanced when patients watch the reflected image of their unaffected limb during training. 1950 65

This article reviews the potential use of visual feedback, focusing on mirror visual feedback, introduced over 15 years ago, for the treatment of many chronic neurological disorders that have long been regarded as intractable such as phantom pain, hemiparesis from stroke and complex regional pain syndrome. Apart from its clinical importance, mirror visual feedback paves the way for a paradigm shift in the way we approach neurological disorders. Instead of resulting entirely from irreversible damage to specialized brain modules, some of them may arise from short-term functional shifts that are potentially reversible. If so, relatively simple therapies can be devised--of which mirror visual feedback is an example--to restore function.
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PMID:The use of visual feedback, in particular mirror visual feedback, in restoring brain function. 1950 71

We have proposed to evaluate different patterns represented on 3-phase bone scintigraphy (TPBS) according to the time course of complex regional pain syndrome (CRPS) type I (CRPS-I) after a stroke or traumatic brain injury. TPBS was performed in 50 consecutive patients for the evaluation of CRPS. We divided the patients into CRPS and non-CPRS groups based on the use of International Association for the Study of Pain criteria. We evaluated the changes on TPBS according to clinical stages based on time course. In the early acute stage within 6 weeks, minimal uptake on all TPBS phases was observed in the 90% of the patients in the CRPS-I group and in 75% of the patients in the non-CRPS group. In the acute stage of CRPS in the range of 2 to 20 weeks, moderately increased uptake was seen for 78%, 83%, and 83% of the patients in the CRPS group for the 3 phases, respectively. However, only 16% of the patients in the non-CRPS group had moderately increased uptake as seen on all TPBS phases. In the late stage of more than 21 weeks, there was no distinct difference in uptake between the 2 groups. A sequential change during the time course for the CPRS-I group was statistically significant (P < 0.05). Therefore, performance of follow-up TPBS may be useful to diagnose CPRS-I in uncertain cases of the early acute stage after a stroke or traumatic brain injury.
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PMID:Patterns of three-phase bone scintigraphy according to the time course of complex regional pain syndrome type I after a stroke or traumatic brain injury. 1985 Nov 72

The objective of this study was to evaluate the clinical aspects of mirror therapy (MT) interventions after stroke, phantom limb pain and complex regional pain syndrome. A systematic literature search of the Cochrane Database of controlled trials, PubMed/MEDLINE, CINAHL, EMBASE, PsycINFO, PEDro, RehabTrials and Rehadat, was made by two investigators independently (A.S.R. and M.J.). No restrictions were made regarding study design and type or localization of stroke, complex regional pain syndrome and amputation. Only studies that had MT given as a long-term treatment were included. Two authors (A.S.R. and S.M.B.) independently assessed studies for eligibility and risk of bias by using the Amsterdam-Maastricht Consensus List. Ten randomized trials, seven patient series and four single-case studies were included. The studies were heterogeneous regarding design, size, conditions studied and outcome measures. Methodological quality varied; only a few studies were of high quality. Important clinical aspects, such as assessment of possible side effects, were only insufficiently addressed. For stroke there is a moderate quality of evidence that MT as an additional intervention improves recovery of arm function, and a low quality of evidence regarding lower limb function and pain after stroke. The quality of evidence in patients with complex regional pain syndrome and phantom limb pain is also low. Firm conclusions could not be drawn. Little is known about which patients are likely to benefit most from MT, and how MT should preferably be applied. Future studies with clear descriptions of intervention protocols should focus on standardized outcome measures and systematically register adverse effects.
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PMID:The clinical aspects of mirror therapy in rehabilitation: a systematic review of the literature. 2132 41

We retrospectively evaluated the safety and efficacy of computed tomography-guided placement of percutaneous catheters in close proximity to the thoracic sympathetic chain by rating pain intensity and systematically reviewing charts and computed tomography scans. Interventions were performed 322 times in 293 patients of mean (SD) age 59.4 (17.0) years, and male to female ratio 105:188, with postherpetic neuralgia (n = 103, 35.1%), various neuralgias (n = 88, 30.0%), complex regional pain syndrome (n = 69, 23.6%), facial pain (n = 17, 5.8%), ischaemic limb pain (n = 7, 2.4%), phantom limb pain (n = 4, 1.4%), pain following cerebrovascular accident (n = 2, 0.7%), syringomyelia (n = 2, 0.7%) and palmar hyperhidrosis (n = 1, 0.3%). The interventions were associated with a total of 23 adverse events (7.1% of all procedures): catheter dislocation (n = 9, 2.8%); increase in pain intensity (n = 8, 2.5%); pneumothorax (n = 3, 0.9%); local infection (n = 2, 0.6%); and puncture of the spinal cord (n = 1, 0.3%). Continuous infusion of 10 ml.h(-1) ropivacaine 0.2% through the catheters decreased median (IQR [range]) pain scores from 8 (6-9 [2-10]) to 2 (1-3 [0-10]) (p < 0.0001). Chemical neuroablation was necessary in 137 patients (46.8%). We conclude that this procedure leads to a significant reduction of pain intensity in otherwise obstinate burning or stabbing pain and is associated with few hazards.
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PMID:Interventional management of intractable sympathetically mediated pain by computed tomography-guided catheter implantation for block and neuroablation of the thoracic sympathetic chain: technical approach and review of 322 procedures. 2156 48

Post-stroke shoulder pain is associated with either a peripheral or central pathology. However, most of the time, it is challenging to establish a cause-and-effect relationship between the suggested pathology and shoulder pain reported. We report a 66 year-old man who developed a right hemiplegic shoulder pain two months post stroke with initial investigations suggestive of peripheral pathologies. Pharmacological and non-pharmacological treatment did not improve his shoulder pain. Later he developed complex regional pain syndrome (CRPS) of the right hand and the initial shoulder pain subsequently relieved following resolution of the CRPS.
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PMID:Concurrent peripheral pathologies and complex regional pain syndrome type 1 as contributors to acute post-stroke shoulder pain: a case report. 2259 81

Neuropathic pain is a complicated symptomatic disease as migraine in recent years. Not because the pain character differed from the nociceptive inflammatory symptoms but because of its complexity of mechanisms. Though peripheral sensitization, ectopic discharge, central sensitization, central re-organization and loss of inhibition play part of roles in mechanisms, however, based on this mechanistic treatment, the outcome still disappointed physicians and patients, exampled as central post-stroke central pain (CPSP). The pain reduction is far less than the expectation from patients and physician's under-treatment frequently occur due to the fear of adverse effects or off-label use of these anti-neuropathic pain drugs. Therefore, a multidisciplinary procedure including non-pharmacological management, rehabilitation program, careful explanation, stepwise pain reduction, daily diary record, and tailored individual planning for medications are helpful in treating this kind of sufferers. Pharmacological treatment is the mainstream in post-herpetic neuralgia (PHN), diabetic peripheral neuropathic pain (DPNP), central post-stroke pain (CPSP), trigeminal neuralgia (TN), complex regional pain syndrome (CRPS), cancer pain, failed back syndrome etc, while polypharmacy is still the major prescriptions facing such kind of miserable patients. The tricyclic antidepressants (TCA), gamma- aminobutyric acid (GABA), voltage-dependent calcium channel blockers, selective non-epinephrine reuptake inhibitor (SNRI), opioid or morphine etc, are still evidence-based medicines (EBM) but with different outcome for individuals. Acupuncture is to some extend effective in Taiwanese people with perceived evidence or placebo. The Taiwan guidance for total pain management and review of EBM in treating neuropathic pain from neurological point of view will be introduced in this manuscript.
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PMID:[Guideline of neuropathic pain treatment and dilemma from neurological point of view]. 2319 35

Mirror training and movement imagery have been demonstrated to be effective in treating several clinical conditions, such as phantom limb pain, stroke-induced hemiparesis, and complex regional pain syndrome. This article presents an augmented reality home-training system based on the mirror and imagery treatment approaches for hand training. A head-mounted display equipped with cameras captures one hand held in front of the body, mirrors this hand, and displays it in real time in a set of four different training tasks: (1) flexing fingers in a predefined sequence, (2) moving the hand into a posture fitting into a silhouette template, (3) driving a "Snake" video game with the index finger, and (4) grasping and moving a virtual ball. The system records task performance and transfers these data to a central server via the Internet, allowing monitoring of training progress. We evaluated the system by having 7 healthy participants train with it over the course of ten sessions of 15-min duration. No technical problems emerged during this time. Performance indicators showed that the system achieves a good balance between relatively easy and more challenging tasks and that participants improved significantly over the training sessions. This suggests that the system is well suited to maintain motivation in patients, especially when it is used for a prolonged period of time.
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PMID:An augmented reality home-training system based on the mirror training and imagery approach. 2433 25


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