title: Thalamic thermo-algesic transmission: ventral posterior (VP) complex versus VMpo in the light of a thalamic infarct with central pain.
abstract: The respective roles of the ventral posterior complex (VP) and of the more recently described VMpo (posterior part of the ventral medial nucleus) as thalamic relays for pain and temperature pathways have recently been the subject of controversy. Data we obtained in one patient after a limited left thalamic infarct bring some new insights into this debate. This patient presented sudden right-sided hypesthesia for both lemniscal (touch, vibration, joint position) and spinothalamic (pain and temperature) modalities. He subsequently developed right-sided central pain with allodynia. Projection of 3D magnetic resonance images onto a human thalamic atlas revealed a lesion involving the anterior two thirds of the ventral posterior lateral nucleus (VPL) and, to a lesser extent, the ventral posterior medial (VPM) and inferior (VPI) nuclei. Conversely, the lesion did not extend posterior and ventral enough to concern the putative location of the spinothalamic-afferented nucleus VMpo. Neurophysiological studies showed a marked reduction (67%) of cortical responses depending on dorsal column-lemniscal transmission, while spinothalamic-specific, CO2-laser induced cortical responses were only moderately attenuated (33%). Our results show that the VP is definitely involved in thermo-algesic transmission in man, and that its selective lesion can lead to central pain. However, results also suggest that much of the spino-thalamo-cortical volley elicited by painful heat stimuli does not transit through VP, supporting the hypothesis that a non-VP locus lying more posteriorly in the human thalamus is important for thermo-algesic transmission.
authors.affiliation: Dept Fisiología, Universidad de Málaga, Campus de Teatinos s/n, 29080 Malaga, Spain. cmontes@uma.es
authors.forename: Carmen
authors.initials: C
authors.lastname: Montes
authors.forename: Michel
authors.initials: M
authors.lastname: Magnin
authors.forename: Joseph
authors.initials: J
authors.lastname: Maarrawi
authors.forename: Maud
authors.initials: M
authors.lastname: Frot
authors.forename: Philippe
authors.initials: P
authors.lastname: Convers
authors.forename: François
authors.initials: F
authors.lastname: Mauguière
authors.forename: Luis
authors.initials: L
authors.lastname: Garcia-Larrea
mesh_terms: D020520:Brain Infarction / Q000473:pathology*; D001931:Brain Mapping; D004569:Electroencephalography / Q000379:methods; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D006930:Hyperalgesia / Q000473:pathology / Q000503:physiopathology; D021621:Imaging, Three-Dimensional / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009434:Neural Pathways / Q000473:pathology* / Q000503:physiopathology; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D010146:Pain / Q000473:pathology* / Q000503:physiopathology; D011930:Reaction Time; D013788:Thalamus / Q000473:pathology* / Q000503:physiopathology