A Case of Thalamic Pain Syndrome after Meningoencephalitis.

Chi,  Hye Mi; Kwahk,  Jae Hyok; Lee,  Cho Ae; Chae,  Kyu Young

Case Report

Journal of the Korean Child Neurology Society 2006;14(1):146-152.
Published online May 30, 2006.

A Case of Thalamic Pain Syndrome after Meningoencephalitis.

Hye Mi Chi, Jae Hyok Kwahk, Cho Ae Lee, Kyu Young Chae

Department of Pediatrics, College of Medicine, Pochon Cha University, Sungnam, Korea. barnabas@cha.ac.kr

Abstract

Thalamic pain syndrome is a type of central pain caused by damage to both thalami and produces persistent and intractable pain; extreme burning or aching sensation by light touch, even without external stimuli. In adults, thalamic pain syndrome occurred in vascular diseases such as a stroke, but in children, it was reported that infectious diseases-upper respiratory infection or meningitis-were usually preceded by development of central pain syndrome. This paper reports on a 12 year old boy with meningoencephalitis followed by evolving to thalamic pain syndrome 10 days later, who suffered from hypersensitivity and severe generalized pain on his whole body. On the brain MRI, both medial temporal lobes showed increased signal intensity, worse on the right side. A combination therapy of intravenous ketamine, amitriptyline and gabapentine for intensive pain control markedly reduced the pain and hypersensitivity in about 1 month. On the following brain SPECT, a strong focal perfusion at the right temporo-parietal cortex area was nearly normalized compared to previous one.

Key Words: Thalamic pain syndrome, Meningoencephalitis