Thalamic Pain Syndrome (Dejerine-Roussy Syndrome)
Definition and scope
Central post-stroke pain (thalamic pain syndrome, Dejerine-Roussy) is a form of central neuropathic pain caused by a lesion of the central somatosensory pathways - classically an infarct of the ventroposterior (ventrocaudal) thalamus. It is characterised by persistent, often severe neuropathic pain with paradoxical sensory loss and altered perception. (NICE CG173)
Key points at a glance
- Affects ≈8% of stroke survivors; particularly associated with thalamic infarcts.
- Onset is often delayed (weeks to months - sometimes years) after the index stroke.
- Pain is commonly unilateral and contralateral to the lesion, described as burning, shooting, stabbing, or aching, and may coexist with numbness, allodynia or “painful numbness” (anaesthesia dolorosa).
- Frequently chronic and difficult to treat; multidisciplinary management is usually required.
Pathophysiology
Thalamic lesions disrupt normal relay and modulation of somatosensory input to cortex. Deafferentation and maladaptive central plasticity produce central sensitisation, disinhibition and spontaneous activity in central nociceptive pathways - producing neuropathic pain despite reduced peripheral sensation.
Clinical presentation
- Typical history: prior stroke (often thalamic) with delayed onset of persistent hemibody pain.
- Pain quality: burning, constant aching with paroxysmal lancinating exacerbations; allodynia to light touch is common.