Mechanism: vascular damage
Frequency: 2-6% of stroke patients (Bowsher)
The condition was first described with vascular injuries involving the thalamus. However, it can occur after a vascular lesion in any part of the central nervous system. The condition may follow subarachnoid hemorrhage.
The onset may be weeks or months after the stroke.
Clinical features:
(1) burning or freezing sensation
(2) allodynia
(3) difficulty distinguishing sharp from blunt or warm from cold in the affected area
(4) exacerbation by stress
(5) it usually does not impact falling asleep
A key feature is that the pain responds poorly to standard analgesics. The pain may respond to:
(1) antidepressants
(2) deep brain electrical stimulation
(3) positive relaxation
(4) mexiletine
