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Thalamic stroke — SCE Neurology MCQ

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HardStrokeThalamic strokeSCE Neurology

Months after a small ventroposterolateral thalamic infarct, a patient develops severe burning allodynia across the contralateral body. Which management principle is most appropriate?

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Correct answer: C — Treat as central post-stroke neuropathic pain with an evidence-based neuropathic-pain medicine and functional pain plan

The best answer is “Treat as central post-stroke neuropathic pain with an evidence-based neuropathic-pain medicine and functional pain plan”. Delayed contralateral burning and allodynia after a thalamic lesion indicate central post-stroke pain; treatment follows neuropathic-pain principles and functional goals. “Repeat thrombolysis because pain proves recurrent infarction” is a credible alternative elsewhere, but it fails the decisive discriminator in this case. “Use long-term opioids as routine first-line therapy” is a credible alternative elsewhere, but it fails the decisive discriminator in this case. “Perform lumbar puncture to confirm thalamic pain” is a credible alternative elsewhere, but it fails the decisive discriminator in this case. “Treat with carbamazepine solely because all neuropathic pain is trigeminal neuralgia” is a credible alternative elsewhere, but it fails the decisive discriminator in this case.

Reference: NICE CG173 neuropathic pain recommendations: https://www.nice.org.uk/guidance/cg173/chapter/1-recommendations