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Abstract
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Background and Aims Central neuropathic pain syndrome is a neurological complication associated with central nervous system damage. Although the pathophysiology of central neuropathic pain has yet to be elucidated, dysfunction of spinal-thalamic-cortical pathway is critical for the development of central neuropathic pain. We present a case of refractory central neuropathic pain resulting from tumor resection of anterior cingulate gyrus that resolved after frontal cerebral hemorrhage.
Methods We assessed this gentleman’s pain by assessing his Visual Analogue Scale (VAS) and reviewing previous management strategies, current medication and impact of the condition on his life. Brain and spine MRI were performed to find the cause of the pain.
Results A 62-year-old man presented with central neuropathic pain in both upper and lower extremities resulting from resection of anterior cingulate gyrus glioma. Pain was 8/10 on the VAS with significant impact on the patient’s psychological well-being. Despite epidural blocks, medications, and cervical/lumbar spinal cord stimulator over a 10-year period, only 30% of the pain was relieved. However, after the surgery for left superior frontal gyrus hemorrhage caused by a slip-down injury, his symptoms were completely resolved.
Recurrent low-grade glioma (3 cm diameter) diagnosed in 2012 (sagittal and transverse MRI T2 images)
Cervical/Lumbar anterior-posterior and lateral X-rays after spinal cord stimulator implantation
Sagittal (T2) and transverse (T1) images obtained after left frontal cerebral hemorrhage and right subdural hematoma
Conclusions In this case, the altered neural firing following tumor resection of anterior cingulate cortex may lead to central sensitization and pathological pain perception. Possible mechanisms of pain relief may involve an increase in inhibitory synapses projecting from frontal cortex to spinal-thalamic- cortical pathway by superior frontal gyrus hemorrhage. This suggests that superior frontal gyrus is an important region in the central pain processing pathway and provides new insight into central pain treatment.