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Central Pain Due to Injury of the Spinothalamic Tract Misdiagnosed as Complex Regional Pain Syndrome: A Case Report.

Abstract

OBJECTIVES

We report on a patient with whiplash injury who had central pain, due to injury of the spinothalamic tract (STT), but who was misdiagnosed as complex regional pain syndrome (CRPS).

CASE DESCRIPTION

While a minivan in which a 43-year-old female was seated in the passenger seat was stopped for a signal, a truck collided with the minivan from behind, and the minivan then repeatedly collided with trucks in front and behind the minivan. Her head repeatedly struck the minivan seat resulting in whiplash injuries. After onset, she felt pain in both legs with mild motor weakness in all four extremities and memory impairment. Eight years after onset, she was diagnosed at a university hospital as CRPS type 1 with the clinical features of hyperalgesia and mild edema and motor weakness of both legs. She visited another university hospital nine years after onset and complained of pain in the right arm and both legs, constant tingling and burning pain along with allodynia and hyperalgesia. She also showed mild weakness in the four extremities, mild edema of both legs, and memory impairment. On diffusion tensor tractography (DTT), the left spinothalamic tract (STT) showed marked narrowing, and the right STT revealed mild narrowing and partial tearing. In addition, partial tears were observed in both corticospinal tracts and the right corticoreticulospinal tract. Discontinuations were observed in the left corticoreticulospinal tract and the left fornical crus.

CONCLUSION

Injury of the STT was demonstrated on DTT in a patient with central pain following whiplash injury. Previously, the patient was misdiagnosed as CRPS.

Authors+Show Affiliations

Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University 317-1, Daemyungdong, Namku, Daegu 705-717, Korea.Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University 317-1, Daemyungdong, Namku, Daegu 705-717, Korea.Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University 317-1, Daemyungdong, Namku, Daegu 705-717, Korea. hssj8020@hanmail.net.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

31597370

Citation

Jang, Sung Ho, et al. "Central Pain Due to Injury of the Spinothalamic Tract Misdiagnosed as Complex Regional Pain Syndrome: a Case Report." Diagnostics (Basel, Switzerland), vol. 9, no. 4, 2019.
Jang SH, Kwon YH, Lee SJ. Central Pain Due to Injury of the Spinothalamic Tract Misdiagnosed as Complex Regional Pain Syndrome: A Case Report. Diagnostics (Basel). 2019;9(4).
Jang, S. H., Kwon, Y. H., & Lee, S. J. (2019). Central Pain Due to Injury of the Spinothalamic Tract Misdiagnosed as Complex Regional Pain Syndrome: A Case Report. Diagnostics (Basel, Switzerland), 9(4), doi:10.3390/diagnostics9040145.
Jang SH, Kwon YH, Lee SJ. Central Pain Due to Injury of the Spinothalamic Tract Misdiagnosed as Complex Regional Pain Syndrome: a Case Report. Diagnostics (Basel). 2019 Oct 8;9(4) PubMed PMID: 31597370.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Central Pain Due to Injury of the Spinothalamic Tract Misdiagnosed as Complex Regional Pain Syndrome: A Case Report. AU - Jang,Sung Ho, AU - Kwon,Young Hyeon, AU - Lee,Sung Jun, Y1 - 2019/10/08/ PY - 2019/08/27/received PY - 2019/10/07/revised PY - 2019/10/08/accepted PY - 2019/10/11/entrez KW - complex regional pain syndrome KW - diffusion tensor tractography KW - spinothalamic tract KW - traumatic axonal injury KW - whiplash injury JF - Diagnostics (Basel, Switzerland) JO - Diagnostics (Basel) VL - 9 IS - 4 N2 - OBJECTIVES: We report on a patient with whiplash injury who had central pain, due to injury of the spinothalamic tract (STT), but who was misdiagnosed as complex regional pain syndrome (CRPS). CASE DESCRIPTION: While a minivan in which a 43-year-old female was seated in the passenger seat was stopped for a signal, a truck collided with the minivan from behind, and the minivan then repeatedly collided with trucks in front and behind the minivan. Her head repeatedly struck the minivan seat resulting in whiplash injuries. After onset, she felt pain in both legs with mild motor weakness in all four extremities and memory impairment. Eight years after onset, she was diagnosed at a university hospital as CRPS type 1 with the clinical features of hyperalgesia and mild edema and motor weakness of both legs. She visited another university hospital nine years after onset and complained of pain in the right arm and both legs, constant tingling and burning pain along with allodynia and hyperalgesia. She also showed mild weakness in the four extremities, mild edema of both legs, and memory impairment. On diffusion tensor tractography (DTT), the left spinothalamic tract (STT) showed marked narrowing, and the right STT revealed mild narrowing and partial tearing. In addition, partial tears were observed in both corticospinal tracts and the right corticoreticulospinal tract. Discontinuations were observed in the left corticoreticulospinal tract and the left fornical crus. CONCLUSION: Injury of the STT was demonstrated on DTT in a patient with central pain following whiplash injury. Previously, the patient was misdiagnosed as CRPS. SN - 2075-4418 UR - https://www.unboundmedicine.com/medline/citation/31597370/Central_Pain_Due_to_Injury_of_the_Spinothalamic_Tract_Misdiagnosed_as_Complex_Regional_Pain_Syndrome:_A_Case_Report DB - PRIME DP - Unbound Medicine ER -
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