Thalamic Pain (Dejerine-Roussy Syndrome) for Neurocysticercosis
Otto J. Hernandez Fustes1*, Renato P. Munhoz2
Affiliation
1Complexo Hospital de Clínicas da Universidade Federal do Paraná, Serviço de Neurologia, Curitiba PR, Brazil
2Department of Medicine, Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
Corresponding Author
Otto J. H. Fustes, Rua General Carneiro 181, SAM 25, 80060-900, Curitiba/PR; E-mail: otto.fustes@hc.ufpr.br
Citation
Hernandez-Fustes Otto, J., et al. Thalamic Pain (Dejerine-Roussy Syndrome) for Neurocysticercosis. (2019) Int J Neurol Brain Dis 6 (2):37.
Copy rights
© 2019 Fustes, Otto J.H. This is an Open access article distributed under the terms of Creative Commons Attribution 4.0 International License.
Introduction
The eponym Dejerine Roussy syndrome (DRS) was coined after the description of an unusual combination of pain with other sensory and motor features, initially designated by the aforementioned authors as “Le syndrome thalamique” based on its clinicopathological correlation[1]. Clinically, the syndrome is characterized by contralateral hemisensory loss, astereognosia, hemialgic crisis described as tight, drawing, icy, and knifelike. Can be aggravated by mild cutaneous stimulation, emotional stress, meteorological changes and tends to develop during partial recovery of the sensory deficit. If the posterior limb of the internal capsule is involved, hemiparesis or hemiplegia may accompany the sensory syndrome. Other associated motor signs include hemiballismus, choreoatetosis, intention tremor and sensory ataxia opposite to the lesion. Similar pain can be produced by a lesion that involves the parietal lobe or the sensory pathways at any point in the cord (posterior columns and spinotalamic tract) or in the brainstem[2]. There are several etiologic theories proposed, which include central imbalance, central disinhibition, central sensitization, the grill illusion theory or thalamic changes, and the inflammatory response of the neural pathway involved[3].
Figure 1: Cranium CT showed a left thalamic calcification.
Figure 2: MRI showed a punctiform (lesion hypointense in T1-weighted images) and hyperintense in T2-weighted images in the left thalamus.
The main cause of thalamic syndrome is the vascular ischemic lesion resulting from the obstruction of the thalamogeniculate artery. Other causes include hemorrhagic stroke, demyelinating disorders, trauma and encephalitis. Illustrating an unusual etiology, we report a 36-years-old left-handed woman, veterinarian, with classic DRS, medically refractory disestesia and pain in the right hemibody caused by a cysticercotic thalamic cyst. She showed relief after treatment with tricyclic antidepressant.
References
1. Cambier J. Dejerine-Roussy syndrome. Rev Neurol (Paris) 1982;138:979-988.
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2. Schott B, Laurent B, Mauguiere F. Thalamic pain: critical study of 43 cases. Rev Neurol (Paris) 1986;142:308-315.
3. Jahngir MU, Qureshi AI. Dejerine Roussy Syndrome. [Updated 2019 Nov 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-.
