Ann Rehabil Med.  2018 Feb;42(1):175-179. 10.5535/arm.2018.42.1.175.

Complex Regional Pain Syndrome of Non-hemiplegic Upper Limb in a Stroke Patient: A Case Report

• Lee A
• Jung Y
• Kwon HK
• Pyun SB

• KMID: 2440983
• DOI: http://doi.org/10.5535/arm.2018.42.1.175

Abstract

Complex regional pain syndrome (CRPS) type I in stroke patients is usually known to affect the hemiplegic upper limb. We report a case of CRPS presented in an ipsilesional arm of a 72-year-old female patient after an ischemic stroke at the left middle cerebral artery territory. Clinical signs such as painful range of motion and hyperalgesia of her left upper extremity, swollen left hand, and dystonic posture were suggestive of CRPS. A three-phase bone scintigraphy showed increased uptake in all phases in the ipsilesional arm. Diffusion tensor tractography showed significantly decreased fiber numbers of the corticospinal tract and the spinothalamic tract in both unaffected and affected hemispheres. Pain and range of motion of the left arm of the patient improved after oral steroids with a starting dose of 50 mg/day.

Keyword

Complex regional pain syndromes; Stroke; Diffusion tensor imaging

MeSH Terms

Aged
Arm
Complex Regional Pain Syndromes
Diffusion
Diffusion Tensor Imaging
Female
Hand
Humans
Hyperalgesia
Middle Cerebral Artery
Posture
Pyramidal Tracts
Radionuclide Imaging
Range of Motion, Articular
Spinothalamic Tracts
Steroids
Stroke*
Upper Extremity*
Steroids

Figure

• 

  Fig. 1 (A) Brain magnetic resonance imaging (T2 FLAIR image, axial view) showing infarction of the left middle cerebral arterial territory. (B) Brain computed tomography image 1 day after infarction showing an acute hemorrhagic transformation resulting in midline shifting.

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  Fig. 2 Dystonia like posture of the left upper limb. Note fingers of the left hand forming a ‘V’ shape (arrow).

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  Fig. 3 Three-phase bone scintigraphy of clinically suspected complex regional pain syndrome (CRPS) of a non-hemiplegic upper limb in the patient with left cerebral infarction. (A) Perfusion phase. Perfusion to the left hand was higher than that to the right hand. (B) Blood pool phase. Blood pool to the left hand was higher than that to the right hand. (C) Delayed phase. Diffusely increased radionuclide uptakes in the left upper extremity.

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  Fig. 4 Tractography for the corticospinal tract (A) and spinothalamic tract (B) showing significant volume reduction in both hemispheres.

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