DEJERINE ROUSSY PDF

The nature of the pain varies considerably between patients, but is often moderate to severe in intensity, can be either persistent or episodic, can be either spontaneous or evoked e. The location of the pain also varies considerably and can affect a large part of the contralateral body or a smaller portion depending on the exact size and location of the thalamic lesion Additionally, the onset of the pain also is extremely variable, with some patients reporting onset immediately, while others years after the stroke Furthermore, and partly because of this, this syndrome is considered by many authors to be a diagnosis of exclusion in patients with a known thalamic stroke Furthermore, tumors including metastases , demyelination , and abscesses involving the thalamus can also cause an identical syndrome 5,6.

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Symptoms[ edit ] Dejerine—Roussy syndrome is most commonly preceded by numbness in the affected side. In these cases, numbness is replaced by burning and tingling sensations, widely varying in degree of severity across all cases. Less commonly, some patients develop severe ongoing pain with little or no stimuli. Most patients experiencing allodynia, experience pain with touch and pressure, however some can be hypersensitive to temperature. It often presents as pain. This form of neuropathic pain can be any combination of itching, tingling, burning, or searing experienced spontaneously or from stimuli.

In general, once the development of pain has stopped, the type and severity of pain will be unchanging and if untreated, persist throughout life. Consequentially, many will undergo some form of pain treatment and adjust to their new lives as best they can. Although debatable, these symptoms are rare and considered part of a "thalamic phenomenon", and are not normally considered a characteristic of Dejerine—Roussy syndrome. In general, strokes damage one hemisphere of the brain, which can include the thalamus.

The thalamus is generally believed to relay sensory information between a variety of subcortical areas and the cerebral cortex. The final product of this communication is the ability to see, hear or feel something as interpreted by the brain. Dejerine—Roussy syndrome most often compromises tactile sensation. Therefore, the damage in the thalamus causes miscommunication between the afferent pathway and the cortex of the brain, changing what or how one feels. Recently, magnetic resonance imaging has been utilized to correlate lesion size and location with area affected and severity of condition.

Although preliminary, these findings hold promise for an objective way to understand and treat patients with Dejerine—Roussy syndrome.

Individuals with emerging Dejerine—Roussy syndrome usually report they are experiencing unusual pain or sensitivity that can be allodynic in nature or triggered by seemingly unrelated stimuli sounds, tastes. Symptoms are typically lateralized and may include vision loss or loss of balance position sense.

Workup should be performed by a neurologist and brain imaging to look for evidence of infarction or tumor should be obtained. Treatments[ edit ] Many chemical medications have been used for a broad range of neuropathic pain including Dejerine—Roussy syndrome.

Symptoms are generally not treatable with ordinary analgesics. Newer pharmaceuticals include anti-convulsants and Kampo medicine. Pain treatments are most commonly administered via oral medication or periodic injections.

Topical In addition, physical therapy has traditionally been used alongside a medication regimen. More recently, electrical stimulation of the brain and spinal cord and caloric stimulation have been explored as treatments.

The most common treatment plans involve a schedule of physical therapy with a medication regimen. Because the pain is mostly unchanging after development, many patients test different medications and eventually choose the regimen that best adapts to their lifestyle, the most common of which are orally and intravenously administered. When intravenously administered, opiates can relieve neuropathic pain but only for a time between 4 and 24 hours.

After this time window, the pain returns and the patient must be treated again. Heavy doses of opiates can also cause constipation , and respiratory depression. More common side effects include light-headedness , dizziness , sedation , itching , nausea , vomiting , and sweating. Specifically, tricyclic anti-depressants such as amitriptyline and selective serotonin reuptake inhibitors have been used to treat this symptom and they are effective to some degree within a short time window. Gabapentin and pregabalin are the most common anti-convulsants.

They have significant efficacy in treatment of peripheral and central neuropathic pain. Treatments last 4—12 hours and in general are well tolerated, and the occurrence of adverse events does not differ significantly across patients.

Commonly reported side-effects are dizziness, decreased intellectual performance, somnolence , and nausea. The chemical is released to the skin to act as a numbing agent that feels cool, then feels warm, much like IcyHot. The patients studied did not respond to anti-depressants and anti-epileptic drugs, and turned to Kampo medicine as a treatment option.

Pain experienced by patients significantly decreased and some had improved dysaesthesia. The mechanism of action blocking pain is currently unknown. Electric stimulation utilizing implants deliver specific voltages to a specific part of the brain for specific durations. More recently, research is being done in radiation therapy as long term treatment of Dejerine—Roussy syndrome.

In general, these studies have concluded initial efficacy in such implants, but pain often re-appears after a year or so. Long-term efficacy of stimulation treatments must be further tested and evaluated. There is a need for a new, less expensive, less invasive form of treatment, two of which are postulated below. Spinal cord stimulation has been studied in the last couple of years. In a long case study, 8 patients were given spinal cord stimulation via insertion of a percutaneous lead at the appropriate level of the cervical or thoracic spine.

Between 36 and months after the stimulations, the patients were interviewed. Spinal cord stimulation is cheaper than brain stimulation and less invasive, and is thus a more promising option for pain treatment. In published, peer-reviewed scientific articles by Dr. Edward L Tobinick, director of the Institute of Neurological Recovery in Boca Raton FL, and other physicians and scientists, the authors have suggested the efficacy of using an already FDA approved drug in a novel, off-label way for post-stroke neurological dysfunction [12] [13] [14] [15] [16] These publications are relevant to Dejerine—Roussy syndrome.

The alleviated symptoms may include reduction in spasticity and reduction in chronic post-stroke pain. The name Dejerine—Roussy syndrome was coined after their deaths.

The syndrome included "…severe, persistent, paroxysmal , often intolerable, pains on the hemiplegic side, not yielding to any analgesic treatment". And thus it was thought that the pain associated after stroke was part of the stroke and lesion repair process occurring in the brain.

The last 50 years have been filled with refractory treatment research. As of the early s, longer treatments lasting months to years have been explored in the continued search for permanent removal of abnormal pain.

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Dejerine–Roussy syndrome

Symptoms[ edit ] Dejerine—Roussy syndrome is most commonly preceded by numbness in the affected side. In these cases, numbness is replaced by burning and tingling sensations, widely varying in degree of severity across all cases. Less commonly, some patients develop severe ongoing pain with little or no stimuli. Most patients experiencing allodynia, experience pain with touch and pressure, however some can be hypersensitive to temperature. It often presents as pain. This form of neuropathic pain can be any combination of itching, tingling, burning, or searing experienced spontaneously or from stimuli.

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Stroke-Induced Pain Is Called Dejerine-Roussy Syndrome

This important area serves as the relay station for sensory information from all over the body. Usually, such a lacunar stroke is specific to areas of the thalamus that receive information about pain, temperature, touch, vibration sense, and pressure from all over the body. When a stroke leads to pain due to damage in these areas, people are said to suffer from the Dejerine-Roussy syndrome. The syndrome is also sometimes called thalamic pain syndrome, or central pain syndrome CPS. A survey showed that nine percent of respondents had central pain syndrome. Those who suffer from it are often dismissed as making it up or exaggerating their pain.

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