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Central post-stroke pain — SCE Neurology MCQ

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ModerateFunctional, Rehabilitation and DVLACentral post-stroke painSCE Neurology

A 36-year-old woman presented with burning hemibody pain months after thalamic infarct. On examination, there was allodynia and reduced pinprick on the affected side. Initial investigations showed: MRI confirmed old contralateral thalamic infarct. What is the most appropriate management?

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Correct answer: A — Urgent stroke-unit care with reperfusion and secondary prevention assessment

Urgent stroke-unit care with reperfusion and secondary prevention assessment is the best answer because the vignette describes Central post-stroke pain: delayed neuropathic pain after thalamic stroke is central post-stroke pain. Empirical intravenous ceftriaxone after blood cultures is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Anticoagulation after excluding contraindications and High-dose glucocorticoids with urgent visual protection are less appropriate because they would require different localisation, timing or test findings; Immediate intravenous lorazepam with airway support would fit a different syndrome. Clinical pearl: complex regional pain syndrome is more regional and limb-autonomic.

Reference: NICE NG127; DVLA Assessing fitness to drive; FND Society guidance