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Correlation of thalamic blood flow redistribution with persistent complex regional pain syndrome in a stroke patient with poor diabetic control.

Hsu KC, Chang ST - J Diabetes Investig (2013)

Bottom Line: We present a right-hemispheric stroke patient with complex regional pain syndrome (CRPS).Symptoms of CRPS developed in conjunction with a corresponding elevation of the contralateral thalamic flow when the glycosylated hemoglobin values were high (16.1% and 13.4%), twice observed as migration from the bottom to the top location of the thalamus.CRPS improved after the glycosylated hemoglobin level reduced to 10.6% and 8.3%.

View Article: PubMed Central - PubMed

Affiliation: Department of Physical Medicine & Rehabilitation Tri-Service General Hospital National Defense Medical Center, Taipei Taichung Veterans General Hospital Taichung Taiwan.

ABSTRACT
We present a right-hemispheric stroke patient with complex regional pain syndrome (CRPS). Symptoms of CRPS developed in conjunction with a corresponding elevation of the contralateral thalamic flow when the glycosylated hemoglobin values were high (16.1% and 13.4%), twice observed as migration from the bottom to the top location of the thalamus. CRPS improved after the glycosylated hemoglobin level reduced to 10.6% and 8.3%. Poor blood sugar control might cause redistribution of thalamic regional blood flow and be associated with the persistence of CRPS in this case.

No MeSH data available.


Related in: MedlinePlus

Brain technetium‐99m ethyl cysteinate dimer single photon emission computed tomography (SPECT). (a) The first SPECT showing a high radioisotope uptake in the lower part of the right thalamus (number 11 and 12). (b) The high uptake is still observed in the right thalamus (number 12 and 13) in the second SPECT. Redistribution of thalamic blood flow with upward migration is considered.
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jdi12104-fig-0001: Brain technetium‐99m ethyl cysteinate dimer single photon emission computed tomography (SPECT). (a) The first SPECT showing a high radioisotope uptake in the lower part of the right thalamus (number 11 and 12). (b) The high uptake is still observed in the right thalamus (number 12 and 13) in the second SPECT. Redistribution of thalamic blood flow with upward migration is considered.

Mentions: A 57‐year‐old woman with a 10‐year medical history of hypertension, type 2 diabetes mellitus, and gradually‐developed tingling and numbness in extremities diagnosed as diabetic neuropathy was admitted to the Tri‐Service General Hospital in Taipei, Taiwan, in November 2010 for acute right cerebral stroke with neurological deficits, including dysarthria, left facial palsy and left‐sided hemiparesis with grade 3 muscle power. Highly elevated (16.1%) glycosylated hemoglobin (HbA1c) was also noted on admission. Magnetic resonance imaging (MRI) of the brain showed an acute infarction in the right median pons. The patient's dysarthria and left facial palsy improved quickly, but localized swelling, allodynia and pain developed in her left upper extremity, after admission. Previously developed symptoms of tingling and numbness in extremities remained almost the same as before. Brain technetium‐99m ethyl cysteinate dimer single photon emission computed tomography (SPECT) showed increased tracer uptake in the right thalamus (Figure 1a), which was consistent with the clinical diagnosis of acute‐onset CRPS.


Correlation of thalamic blood flow redistribution with persistent complex regional pain syndrome in a stroke patient with poor diabetic control.

Hsu KC, Chang ST - J Diabetes Investig (2013)

Brain technetium‐99m ethyl cysteinate dimer single photon emission computed tomography (SPECT). (a) The first SPECT showing a high radioisotope uptake in the lower part of the right thalamus (number 11 and 12). (b) The high uptake is still observed in the right thalamus (number 12 and 13) in the second SPECT. Redistribution of thalamic blood flow with upward migration is considered.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4020266&req=5

jdi12104-fig-0001: Brain technetium‐99m ethyl cysteinate dimer single photon emission computed tomography (SPECT). (a) The first SPECT showing a high radioisotope uptake in the lower part of the right thalamus (number 11 and 12). (b) The high uptake is still observed in the right thalamus (number 12 and 13) in the second SPECT. Redistribution of thalamic blood flow with upward migration is considered.
Mentions: A 57‐year‐old woman with a 10‐year medical history of hypertension, type 2 diabetes mellitus, and gradually‐developed tingling and numbness in extremities diagnosed as diabetic neuropathy was admitted to the Tri‐Service General Hospital in Taipei, Taiwan, in November 2010 for acute right cerebral stroke with neurological deficits, including dysarthria, left facial palsy and left‐sided hemiparesis with grade 3 muscle power. Highly elevated (16.1%) glycosylated hemoglobin (HbA1c) was also noted on admission. Magnetic resonance imaging (MRI) of the brain showed an acute infarction in the right median pons. The patient's dysarthria and left facial palsy improved quickly, but localized swelling, allodynia and pain developed in her left upper extremity, after admission. Previously developed symptoms of tingling and numbness in extremities remained almost the same as before. Brain technetium‐99m ethyl cysteinate dimer single photon emission computed tomography (SPECT) showed increased tracer uptake in the right thalamus (Figure 1a), which was consistent with the clinical diagnosis of acute‐onset CRPS.

Bottom Line: We present a right-hemispheric stroke patient with complex regional pain syndrome (CRPS).Symptoms of CRPS developed in conjunction with a corresponding elevation of the contralateral thalamic flow when the glycosylated hemoglobin values were high (16.1% and 13.4%), twice observed as migration from the bottom to the top location of the thalamus.CRPS improved after the glycosylated hemoglobin level reduced to 10.6% and 8.3%.

View Article: PubMed Central - PubMed

Affiliation: Department of Physical Medicine & Rehabilitation Tri-Service General Hospital National Defense Medical Center, Taipei Taichung Veterans General Hospital Taichung Taiwan.

ABSTRACT
We present a right-hemispheric stroke patient with complex regional pain syndrome (CRPS). Symptoms of CRPS developed in conjunction with a corresponding elevation of the contralateral thalamic flow when the glycosylated hemoglobin values were high (16.1% and 13.4%), twice observed as migration from the bottom to the top location of the thalamus. CRPS improved after the glycosylated hemoglobin level reduced to 10.6% and 8.3%. Poor blood sugar control might cause redistribution of thalamic regional blood flow and be associated with the persistence of CRPS in this case.

No MeSH data available.


Related in: MedlinePlus