Disclosures: Alal Uddin, MD: No financial relationships or conflicts of interest

Case Diagnosis: A 57-year-old male with chronic right leg pain presented after a stroke

Case Description or Program Description: A 57-year-old male was admitted to acute inpatient rehab after left posterior cerebellar and lateral medullary stroke. He had a history 25 years previously of a fall followed by right lower leg medial and lateral compartment syndromes necessitating fasciotomy. This resulted in constant severe neuropathic pain and ankle contracture.

Setting: Academic hospital

Assessment/Results: The patient reported that immediately following the stroke his pain of 25 years was completely abolished! The patient found this most pleasing, and also noted that since the stroke with no pain he is now able to walk with his entire right foot touching the ground. On exam, strength is 5/5 in bilateral lower extremities except right ankle. Light touch is intact in the right leg but pain and temperature sensation are absent.

Discussion (relevance): A lateral medullary stroke is known to cause decreased pain and temperature sensation. Here, fascinatingly, it also vanquished a debilitating chronic pain syndrome. No such case was noted on literature review. Patients with lateral medullary stroke syndrome could present with vertigo, nystagmus, Horner syndrome, ataxia, contralateral extremity hypoalgesia and decreased temperature sensation in the trunk. Rare presentations reported in literature include facial pain, eyelid edema, conjunctival injection, eye pain, headache in trigeminal nerve distribution, sensory deficits are noted below a certain spinal level and central post-stroke pain anywhere along trigeminal and/or spinothalamic distribution.

Conclusions: This case report could provide an impetus for neurosurgical treatment of various pain generators in the brain for patients with chronic intractable pain.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-welcome-stroke-in-a-patient-with-chronic-intractable-pain/