Voxel–based lesion mappingを用いた中枢性脳卒中後疼痛の病態解析

細見 晃一, 清水 豪士, 後藤 雄子, 眞野 智生, 角野 喜則, 押野 悟, 貴島 晴彦, 吉峰 俊樹, 齋藤 洋一

doi:10.11154/pain.31.228

Objective. Although central poststroke pain (CPSP)might be understood as a network reorganization disorder that leads to a maladaptive central state, the mechanisms of CPSP are poorly understood. In this study, we investigated key structures to develop CPSP using voxel–based lesion mapping.Methods. Subjects were 98 CPSP patients with three–dimensional T1 weighted images (mean age, 61.4 ± 8.8 years; thalamic lesion, n=45; putaminal lesion, n=41; brainstem lesion, n=9; cortical ⁄ subcortical lesion, n=3). The stroke lesion was segmented as a three–dimensional volume on MR images. These volumes of interest were spatially normalized, and group voxel–based analyses were performed with SPM12 to detect an overlap of the lesions.Results. The overlaps of the stroke lesion were localized in the two structures, the putamen and thalamus. The overlap in the putamen extended in an anteroposterior direction, and its peak was located at the most posterior part of the putamen. The damage of the posterior limb of the internal capsule has been thought to cause CPSP up to now, however the finding from this study suggested that the insular cortex, secondary somatosensory area, and neural connections toward these regions could be involved in development of CPSP. The peak of the thalamic lesion was located at the border of the ventral posterior nucleus and pulvinar. The posterior ventral medial nucleus of the thalamus, which was a proposed relay point for thermosensory and nociceptive fibers, could be also involved in development of CPSP.Conclusions. This study suggested that the specific lesions in the thalamus or putamen could develop CPSP, and the damage of the thalamic insular pathway was one of the key structure to develop CPSP.

<b>Voxel–based lesion mappingを用いた中枢性脳卒中後疼痛の病態解析</b>

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