Zentraler neuropathischer Schmerz nach Schlaganfall

Zusammenfassung

Es besteht eine Vielzahl sich häufig überlappender Schmerzentitäten nach Schlaganfall. Zentraler neuropathischer Schmerz nach Schlaganfall (CPSP) findet sich bei ca. 8% aller Patienten. Eine direkte Schädigung des spinothalamischen Traktes ist eine Voraussetzung für die Entstehung von CPSP. Patienten weisen neben Veränderungen der Schmerz- und Temperaturwahrnehmung bilaterale Atrophien der grauen Substanz auf sowie sensorische Defizite auf der initial klinisch nicht betroffenen Körperhälfte. Für die Diagnose sind neben der zeitlichen und örtlichen (somatotopen) Korrelation zum Schlaganfall der Nachweis negativer oder positiver sensorischer Symptome sowie der Ausschluss anderer Schmerzursachen erforderlich. Die Behandlung des CPSP ist schwierig und die Studienlage für die medikamentöse Therapie unbefriedigend. Mittel der ersten Wahl sind Antikonvulsiva oder Antidepressiva unter Berücksichtigung anderer Begleiterkrankungen und gegebenenfalls in Kombination.

Summary

A number of different overlapping pain entities after stroke does exist. Central post stroke pain (CPSP) has an overall prevalence of about 8% in stroke patients. A lesion to the spinothalamic tract seems to be a necessary prerequisite for CPSP. These Patients show abnormalities in temperature and pain sensation as well as sensory abnormalities on the homologous ipsilesional body side, accompanied by bilaterally spread cortical atrophy. Besides temporal and somatotopic correlation to the stroke lesion, the diagnosis of CPSP requires the presence of pain and/or distinct positive and negative sensory signs, and the exclusion of other pain entities. Treatment of CPSP is difficult, and conclusive study data are rare. Anticonvulsants and antidepressants are drugs of first choice but co-morbidities need to be considered.

Schlüsselwörter

Schlaganfall - zentraler Schmerz - neuropathischer Schmerz

Keywords

Stroke - central pain - neuropathic pain

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