Objectives: We investigated the relationship between injury of the spino-thalamo-cortical pathway (STP) and central post-stroke pain (CPSP) in patients with intracerebral hemorrhage, using diffusion tensor tractography (DTT). Methods: 30 consecutive chronic patients, in whom integrity of the STP and the medial lemnisco-thalamo-cortical pathway (MLP) were spared in both hemispheres, were recruited. We classified the patients into two groups according to the presence of the CPSP. DTTs were obtained using the FMRIB Software Library. Fractional anisotropy (FA), mean diffusivity (MD), and tract volume were measured. A laterality index (LI) was used to determine asymmetry of DTT parameters between the hemispheres. Results: The LI for tract volume of the STP in the CPSP group was lower than that of the non-CPSP group (p = 0.000). However, there were no differences between the CPSP group and non-CPSP group for the LIs of FA or MD of the STP or for the LIs of FA, MD, or tract volume of the MLP (p > 0.05). Conclusions: Decrease of tract volume without changes in the STP FA or MD values in the CPSP group indicates partial injury of STP. Therefore, injury of the STP seems to be a requirement for the development of CPSP in patients with intracerebral hemorrhage.

Andersen G, Vestergaard K, Ingeman-Nielsen M, Jensen TS: Incidence of central post-stroke pain. Pain 1995;61:187–193.
Klit H, Finnerup NB, Jensen TS: Central post-stroke pain: clinical characteristics, pathophysiology, and management. Lancet Neurol 2009;8:857–868.
Cesaro P, Mann MW, Moretti JL, Defer G, Roualdes B, Nguyen JP, et al: Central pain and thalamic hyperactivity: a single photon emission computerized tomographic study. Pain 1991;47:329–336.
Latremoliere A, Woolf CJ: Central sensitization: a generator of pain hypersensitivity by central neural plasticity. J Pain 2009;10:895–926.
Wasner G, Lee BB, Engel S, McLachlan E: Residual spinothalamic tract pathways predict development of central pain after spinal cord injury. Brain 2008;131:2387–2400.
Boivie J, Leijon G, Johansson I: Central post-stroke pain – a study of the mechanisms through analyses of the sensory abnormalities. Pain 1989;37:173–185.
Canavero S, Pagni CA, Castellano G, Bonicalzi V, Bello M, Duca S, et al: The role of cortex in central pain syndromes: preliminary results of a long-term technetium- 99 hexamethylpropyleneamineoxime single photon emission computed tomography study. Neurosurgery 1993;32:185–191.
Goto T, Saitoh Y, Hashimoto N, Hirata M, Kishima H, Oshino S, et al: Diffusion tensor fiber tracking in patients with central post-stroke pain; correlation with efficacy of repetitive transcranial magnetic stimulation. Pain 2008;140:509–518.
Seghier ML, Lazeyras F, Vuilleumier P, Schnider A, Carota A: Functional magnetic resonance imaging and diffusion tensor imaging in a case of central post-stroke pain. J Pain 2005;6:208–212.
Vestergaard K, Nielsen J, Andersen G, Ingeman-Nielsen M, Arendt-Nielsen L, Jensen TS: Sensory abnormalities in consecutive, unselected patients with central post-stroke pain. Pain 1995;61:177–186.
Bowsher D, Leijon G, Thuomas KA: Central post-stroke pain: correlation of MRI with clinical pain characteristics and sensory abnormalities. Neurology 1998;51:1352–1358.
Hong JH, Son SM, Jang SH: Identification of spinothalamic tract and its related thalamocortical fibers in human brain. Neurosci Lett 2009;468:102–105.
Misra UK, Kalita J, Kumar B: A study of clinical, magnetic resonance imaging, and somatosensory-evoked potential in central post-stroke pain. J Pain 2008;9:1116–1122.
Kamali A, Kramer LA, Butler IJ, Hasan KM: Diffusion tensor tractography of the somatosensory system in the human brainstem: initial findings using high isotropic spatial resolution at 3.0 T. Eur Radiol 2009;19:1480–1488.
Yamada K, Nagakane Y, Yoshikawa K, Kizu O, Ito H, Kubota T, et al: Somatotopic organization of thalamocortical projection fibers as assessed with MR tractography. Radiology 2007;242:840–845.
Yang DS, Hong JH, Byun WM, Kwak SY, Ahn SH, Lee H, et al: Identification of the medial lemniscus in the human brain: combined study of functional MRI and diffusion tensor tractography. Neurosci Lett 2009;459:19–24.
Basser PJ, Pierpaoli C: Microstructural and physiological features of tissues elucidated by quantitative-diffusion-tensor MRI. J Magn Reson B 1996;111:209–219.
Mori S, Crain BJ, Chacko VP, van Zijl PC: Three-dimensional tracking of axonal projections in the brain by magnetic resonance imaging. Ann Neurol 1999;45:265–269.
Alexander AL, Lee JE, Lazar M, Field AS: Diffusion tensor imaging of the brain. Neurotherapeutics 2007;4:316–329.
Assaf Y, Pasternak O: Diffusion tensor imaging-based white matter mapping in brain research: a review. J Mol Neurosci 2008;34:51–61.
Neil JJ: Diffusion imaging concepts for clinicians. J Magn Reson Imaging 2008;27:1–7.
Pagani E, Agosta F, Rocca MA, Caputo D, Filippi M: Voxel-based analysis derived from fractional anisotropy images of white matter volume changes with aging. Neuroimage 2008;41:657–667.
Stadlbauer A, Salomonowitz E, Strunk G, Hammen T, Ganslandt O: Quantitative diffusion tensor fiber tracking of age-related changes in the limbic system. Eur Radiol 2008;18:130–137.
Lincoln NB, Jackson JM, Adams SA: Reliability and revision of the Nottingham Sensory Assessment for stroke patients. Physiotherapy 1998;84:358–365.
Flaherty SA: Pain measurement tools for clinical practice and research. AANA J 1996;64:133–140.
Miller MD, Ferris DG: Measurement of subjective phenomena in primary care research: the Visual Analogue Scale. Fam Pract Res J 1993;13:15–24.
Smith SM, Jenkinson M, Woolrich MW, Beckmann CF, Behrens TE, Johansen-Berg H, et al: Advances in functional and structural MR image analysis and implementation as FSL. Neuroimage 2004;23(suppl 1): S208–S219.
Behrens TE, Johansen-Berg H, Woolrich MW, Smith SM, Wheeler-Kingshott CA, Boulby PA, et al: Non-invasive mapping of connections between human thalamus and cortex using diffusion imaging. Nat Neurosci 2003;6:750–757.
Behrens TE, Berg HJ, Jbabdi S, Rushworth MF, Woolrich MW: Probabilistic diffusion tractography with multiple fibre orientations: What can we gain? Neuroimage 2007;34:144–155.
Habas C, Cabanis EA: Anatomical parcellation of the brainstem and cerebellar white matter: a preliminary probabilistic tractography study at 3 T. Neuroradiology 2007;49:849–863.
Naidich T: Duvernoy’s Atlas of the Human Brain Stem and Cerebellum. New York, Springer, 2007.
Salamon N, Sicotte N, Alger J, Shattuck D, Perlman S, Sinha U, et al: Analysis of the brainstem white-matter tracts with diffusion tensor imaging. Neuroradiology 2005;47:895–902.
Schmahmann JD, Pandya DN: Fiber Pathways of the Brain. Oxford, Oxford University Press, 2006.
Ducreux D, Attal N, Parker F, Bouhassira D: Mechanisms of central neuropathic pain: a combined psychophysical and fMRI study in syringomyelia. Brain 2006;129:963–976.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.