title: Thalamic cramplike pain.
abstract: OBJECTIVE
  We describe a case of cramplike pain after a left thalamic ischemic stroke, a neglected type of central post-stroke pain and we describe its neuroanatomical correlates.
  
  
  METHODS
  A 68-year-old right-handed man presented with right arm, leg, and flank cramplike pain noted upon awakening. Neurological examination was normal, with no evidence of objective sensory abnormalities. Because of the nature of the pain and the preserved sensory function, we first did not consider stroke as a potential cause, and suspected that pain was related to the combined effect of intense physical exercising on the right side and the use of statins. Diffusion-weighted magnetic resonance imaging showed an acute ischemic infarction within the left thalamus. By registering high-resolution 3 T T1-weighted and T2-weighted magnetic resonance images to the Talairach atlas, we showed the infarction is within the border between the pulvinar and the ventral posterior medial nuclei. Brodmann's areas 3, 1, 2, 4 and 6 were identified as the cortical correlates of the ischemic lesion by diffusion tensor tractography.
  
  
  CONCLUSIONS
  Thalamic cramplike pain should be recognized as a type of central post-stroke pain, probably produced by lesions localized to the border between the ventral posterior and pulvinar nuclei and connected to the ipsilateral primary somatosensory cortex and primary and secondary motor cortices.
authors.affiliation: Department of Clinical Neurological Sciences, London Health Sciences Centre, University of Western Ontario, London, ON, Canada. Electronic address: lucianosposato@gmail.com.
authors.forename: Luciano A
authors.initials: LA
authors.lastname: Sposato
authors.affiliation: Robarts Research Institute, University of Western Ontario, London, ON, Canada; Department of Medical Biophysics, University of Western Ontario, London, ON, Canada.
authors.forename: Harish A
authors.initials: HA
authors.lastname: Sharma
authors.affiliation: Robarts Research Institute, University of Western Ontario, London, ON, Canada; Department of Medical Biophysics, University of Western Ontario, London, ON, Canada.
authors.forename: Ali R
authors.initials: AR
authors.lastname: Khan
authors.affiliation: Robarts Research Institute, University of Western Ontario, London, ON, Canada; Department of Medical Biophysics, University of Western Ontario, London, ON, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Bartha
authors.affiliation: Department of Clinical Neurological Sciences, London Health Sciences Centre, University of Western Ontario, London, ON, Canada.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Hachinski
mesh_terms: D000368:Aged; D002544:Cerebral Infarction / Q000150:complications / Q000175:diagnosis*; D056324:Diffusion Tensor Imaging / Q000379:methods; D006801:Humans; D008297:Male; D009120:Muscle Cramp / Q000175:diagnosis* / Q000209:etiology; D010146:Pain / Q000175:diagnosis* / Q000209:etiology; D013788:Thalamus / Q000473:pathology*
keywords: Cerebrovascular; Cramps; Neuroanatomy; Pain; Stroke; Thalamus; Topography; Tractography