Marshall T Holland1, Mario Zanaty1, Luyuan Li1, Teri Thomsen2, James H Beeghly3, Jeremy D W Greenlee4, Chandan G Reddy1. 1. Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, United States. 2. Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA, United States. 3. Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, United States. 4. Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, United States. Electronic address: jeremy-greenlee@uiowa.edu.
Abstract
BACKGROUND: Central post-stroke pain is known to be refractory to medications and difficult to manage. We present a case of central post-stroke pain associated with dystonia. Both conditions were successfully treated with a single deep brain stimulation (DBS) operation. CASE DESCRIPTION: A 60-year-old female suffered a right posterior cerebral artery stroke following emergent clipping of a ruptured posterior cerebral artery aneurysm resulting in central post-stroke pain. This manifested as delayed left face and hemibody allodynia and hyperesthesia. The patient also developed marked left-sided dystonia. These progressive symptoms were disabling and refractory to conservative management. The patient underwent a single-stage DBS surgery with stereotactic targeting and implantation of two leads. One lead was placed in the right-sided ventral capsule/ventral striatum for treatment of pain and a second lead in the right-sided globus pallidus interna for treatment of dystonia. The surgical implantation proceeded without complication. The patient's dystonia markedly improved following surgery. While her pain improved, she required multiple, meticulous programing sessions to achieve significant pain relief and decrease in pain medication use. Overall, the patient was satisfied with the results of her intervention. She did, however, have occasional intermittent spells of severe pain on top of her residual discomfort throughout her treatment course. Unfortunately, she died from small cell lung carcinoma a year after her DBS surgery. CONCLUSIONS: Deep brain stimulation targeting multiple brain networks in one operation is feasible and safe. Deep brain stimulation may be considered in some refractory cases of central post-stroke pain; however, it requires meticulous programming.
BACKGROUND: Central post-stroke pain is known to be refractory to medications and difficult to manage. We present a case of central post-stroke pain associated with dystonia. Both conditions were successfully treated with a single deep brain stimulation (DBS) operation. CASE DESCRIPTION: A 60-year-old female suffered a right posterior cerebral artery stroke following emergent clipping of a ruptured posterior cerebral artery aneurysm resulting in central post-stroke pain. This manifested as delayed left face and hemibody allodynia and hyperesthesia. The patient also developed marked left-sided dystonia. These progressive symptoms were disabling and refractory to conservative management. The patient underwent a single-stage DBS surgery with stereotactic targeting and implantation of two leads. One lead was placed in the right-sided ventral capsule/ventral striatum for treatment of pain and a second lead in the right-sided globus pallidus interna for treatment of dystonia. The surgical implantation proceeded without complication. The patient's dystonia markedly improved following surgery. While her pain improved, she required multiple, meticulous programing sessions to achieve significant pain relief and decrease in pain medication use. Overall, the patient was satisfied with the results of her intervention. She did, however, have occasional intermittent spells of severe pain on top of her residual discomfort throughout her treatment course. Unfortunately, she died from small cell lung carcinoma a year after her DBS surgery. CONCLUSIONS: Deep brain stimulation targeting multiple brain networks in one operation is feasible and safe. Deep brain stimulation may be considered in some refractory cases of central post-stroke pain; however, it requires meticulous programming.