Neural substrates for poststroke complex regional pain syndrome type I: a retrospective case–control study using voxel-based lesion symptom mapping analysis

Kwon

et al. 2021

Sci Rep

Complex regional pain syndrome (CRPS) is a common poststroke complication. However, the neural substrates associated with CRPS remain unclear. We investigated the neural correlates associated with poststroke CRPS using voxel-based lesion‒symptom mapping (VLSM) analysis. Among 145 patients with ischemic stroke, 35 were diagnosed with CRPS and categorized into the poststroke CRPS group, and the remaining 110 into the control group. We compared the clinical characteristics between the groups. VLSM analysis was performed to identify the brain region associated with the development of poststroke CRPS. The clinical findings suggested that the poststroke CRPS group had lower muscle strength; lower scores on Fugl‒Meyer assessment, Manual Function Test, Mini-Mental Status Examination; and higher incidence of absent somatosensory evoked potentials in the median nerve than the control group. The head of the caudate nucleus, putamen, and white matter complexes in the corona radiata were significantly associated with poststroke CRPS development in ischemic stroke patients. These results facilitate an understanding of poststroke CRPS pathophysiology. Monitoring patients with lesions in these structures may aid the prevention and early treatment of poststroke CRPS.

Section: Discussionsupporting

confidence: 91%

mentioning

confidence: 99%

Neuroanatomical correlates of poststroke complex regional pain syndrome: a voxel-based lesion symptom-mapping study

Kwon

et al. 2021

Sci Rep

“…These results were similar to those of a recent VLSM study, which reported that the CST and lentiform nucleus were associated with poststroke CRPS. 11 The caudate nucleus and putamen are also known for their role in the pain pathway. 9,26 A previous study using a human functional MRI revealed that, when noxious stimuli were applied, the caudate nucleus was activated bilaterally.…”

Section: Discussionmentioning

confidence: 99%

“…10 To date, only one study has used VLSM analysis to identify the lesion responsible for the development of poststroke CRPS. 11 The study revealed that poststroke CRPS could be associated with damage to the corticospinal tract (CST) and the adjacent lentiform nucleus. However, that study had some limitations.…”

mentioning

confidence: 99%

Neuroanatomical correlates of poststroke complex regional pain syndrome: A voxel-based lesion symptom- mapping study

Lee¹,

Kwon²,

Lee³

et al. 2021

Preprint

Complex regional pain syndrome (CRPS) is a common poststroke complication. However, the neural substrates associated with CRPS remain unclear. We investigated the neural correlates associated with poststroke CRPS using voxel-based lesion‒symptom mapping (VLSM) analysis. Among 145 patients with ischemic stroke, 35 were diagnosed with CRPS and categorized into the poststroke CRPS group, and the remaining 110 into the control group. We compared the clinical characteristics between the groups. VLSM analysis was performed to identify the brain region associated with the development of poststroke CRPS. It suggested that damage to the caudate nucleus head, putamen, and white matter complexes in the corona radiata were significantly associated with poststroke CRPS development. The clinical findings suggested that the poststroke CRPS group had lower muscle strength; lower scores on Fugl‒Meyer assessment, Manual Function Test, Mini-Mental Status Examination; and higher incidence of absent somatosensory evoked potentials in the median nerve than the control group. The head of the caudate nucleus, putamen, and white matter complexes in the corona radiata were associated with poststroke CRPS development in ischemic stroke patients. These results facilitate an understanding of poststroke CRPS pathophysiology. Monitoring patients with lesions in these structures may aid the prevention and early treatment of poststroke CRPS.

“…Most poststroke CRPS is considered CRPS type one, also known as reflex sympathetic dystrophy. The pathogenesis of poststroke CRPS is still unclear [3], and the prevalence varies from 2% to 50% based on previous studies [4]. Poststroke CRPS usually occurs one to six months after a cerebrovascular accident (CVA), which happens to be the period with the highest potential for rehabilitation [5].…”

Section: Introductionmentioning

confidence: 99%

A Meta-Analysis and Meta-Regression of Frequency and Risk Factors for Poststroke Complex Regional Pain Syndrome

Guo

Hsieh

et al. 2021

Medicina

Background and Objectives: This article aimed to investigate the risk factors for poststroke complex regional pain syndrome (CRPS). Materials and Methods: We searched electronic databases including PubMed, Medline, Web of Science, Cochrane Library, and Embase up to 27 October 2021. We enrolled analytical epidemiological studies comprising cohort, case-control, and cross-sectional studies. A quality assessment was performed using the Newcastle–Ottawa Quality Assessment Scale for cohort and case-control studies and the Joanna Briggs Institute critical appraisal checklist for analytical cross-sectional studies. Binary outcomes were reported as odds ratios (ORs), and continuous outcomes were described as standardized mean differences (SMDs) with 95% confidence intervals. For the meta-regression, beta coefficient and p value were adopted. Results: We included 21 articles comprising 2225 participants. Individuals with shoulder subluxation and spasticity were found to have higher risks for poststroke CRPS. Spasticity with higher modified Ashworth scale score, lower Brunnstrom hand stage, and inferior Barthel index scores were observed in patients with poststroke CRPS. The pooled incidence proportion in nine articles was 31.7%, and a correlation was found between effect sizes and the ratio of women and the proportion of left hemiparesis. The summarized prevalence in nine cross-sectional studies was 33.1%, and a correlation was observed between prevalence and the subluxation ratio and Brunnstrom stage. Conclusions: Based on our meta-analysis, being female, left hemiparesis, shoulder subluxation, spasticity, a lower Brunnstrom stage of distal upper limb, and an inferior Barthel index are all features for poststroke CRPS. Larger studies with greater statistical power may confirm our findings and clarify some other unknown risk factors for poststroke CRPS.