22. European Stroke Conference 123 Interesting and challenging cases Stroke Cured A Chronic Complex Regional Pain Syndrome (CRPS) A. NASIM1, K. PASCO2, T. Daniela3, A. BLIGHT4 The Royal Surrey County Hospital NHS Foundation Trust, Guildford, UNITED KINGDOM1, The Royal Surrey County Hospital NHS Foundation Trust, Guildford, UNITED KINGDOM2, The Royal Surrey County Hospital NHS Foundation Trust, Guildford, UNITED KINGDOM3, The Royal Surrey County Hospital NHS Foundation Trust, Guildford, UNITED KINGDOM4 Background:CRPS;neuropathic pain state often needing a multidisciplinary approach.We report an interesting case of a 56yr old lady who was cured of chronic CRPS after a ischemic stroke. Case Report:Ms JI was operated for ® carpel tunnel in 2000;post surgery develop swelling,red-ness, hyperalgesia,hypersensitivity of whole ® arm.Deep burning pain affecting whole limb,worse in dependent position,aggravated by skin stroking,cold/heat sensation.Intolerant to clothes/jewelleries on her skin.Post 06 months referred to pain clinic;diagnosed as CRPS type1 syndrome.Was on lido-caine 5% patch,Pregablin,Paracetamol,Amitriptylline,Morphine.Had 2 regional nerve blocks.Later scheduled for cervical root block. 27th July 2012 Ms JI woke up with RSW/ slurred speech.Striking-ly noticed absence of pain in ® arm.Wake up stroke call to the stroke unit(NIHSS- 4).CT head-small vessel ischemic changes.Given aspirin 300mgs.MR brain-acute stroke in the (L)Thalamus/corona radiata.Good recovery,discharged home.® arm redness,sweating,hypersensitivity resolved within days;swelling reduced over few weeks.She could now wear bracelet and rings without any prob-lem. RSW improved significantly.Discussion:CRPS;painful disabling disorder affecting one/more extremities,precipitated by local injury;fracture,sprain,local surgery.Diagnostic criteria;pain dispro-portionate to precipitating event with coexisting sensory abnormalities(allodynia),oedema,autonom-ic dysfunction,motor symptoms +/- trophic changes.02 subclasses(IASP)(3):CRPS1:pain with no nerve lesion & CRPS2:obvious nerve damage.CRPS is a CNS disorder,with pathogenic sympathetic dysfunction (1).Thalamus receives projections from multiple ascending pain pathways.Chronic pain studies established direct relationship between abnormal thalamic rhythmicity called Thalamo-cor-tical Dysrhythmia(TCD) and CRPS type1(2).Ample evidence suggests vital thalamic role in hyper-algesic responses associated with nerve injury(4).Ischemia changes thalamic blood flow by altering the response properties of thalamic neurons in neuropathic pain models(5).We hypothesise that isch-emic stroke inhibited the thalamic dysrythmia curing her decade long tormenting CRPS Type1. 346 © 2013 S. Karger AG, Basel Scientific Programme Interesting and challenging cases (PO 123 - 190)
Karger_ESC London_2013
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