Whole-body reversible neuropathic pain associated with right parieto-temporal operculum single inflammatory lesion in a patient with multiple sclerosis: A case report

European Journal of Pain : EJP
Louis Poncet-MegemontXavier Moisset

Abstract

The posterior insula and the medial parietal operculum (PIMO) are part of the pain network. Pain can be induced by direct stimulation of the PIMO, but the clinical consequence of lesions in this brain area is not well known. We report the case of a patient with multiple sclerosis who presented a relapse characterized by isolated widespread neuropathic pain. The MRI displayed a single new inflammatory lesion in the juxta cortical white matter of the opercular region. This lesion was extended to the parietal operculum and was associated with the pain syndrome. The patient was treated with high-dose intravenous methylprednisolone, and the pain disappeared progressively. Diffusion-tensor MRI showed that some of the fibres passing through the lesion ended in the PIMO. Based on diffusion-tensor MRI we hypothesize that the partial disconnection from afference to the PIMO can lead to widespread neuropathic pain. Most of the data concerning the functional role of the PIMO come from stereoelectroencephalography in presurgical evaluation of epilepsy, or from functional imaging (PET or fMRI). There is, however, very few data on the consequences of the lesion of the PIMO. Here, we report the first case of a transient widespread pain syndrom...Continue Reading

References

May 22, 2007·NeuroImage·Xavier Moisset, Didier Bouhassira
Aug 21, 2010·Brain : a Journal of Neurology·Luis Garcia-LarreaMichel Magnin
Nov 1, 2011·Brain : a Journal of Neurology·Laure MazzolaFrançois Mauguière
Aug 28, 2014·NeuroImage. Clinical·D SeixasI Tracey
Jan 16, 2015·Neurology·Alexandra MontavontJean Isnard
Mar 10, 2018·Handbook of Clinical Neurology·Luis Garcia-Larrea, François Mauguière

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