211 - Stroke of Luck? Resolution of Chronic Multiple Sclerosis Associated Central Neuropathic Pain Following Stroke

Case Diagnosis: Primary progressive multiple sclerosis with central neuropathic pain, resolved following right temporoparietal intracerebral hemorrhage

Case Description: 61-year-old female with Multiple Sclerosis(MS) on long term Disease Modifying therapy(DMT), optic neuritis and associated chronic refractory bilateral lower extremity(BLE) neuropathy as a complication of MS, was admitted following a sudden onset of left hemiplegia resulting from a spontaneous aright temporal hemorrhage. Her systolic blood pressure at presentation was in 200’s. A STAT Head CT and follow-up MRI confirmed hemorrhage (5.7x5.2x3.7cm) with persistent localized mass effect including sulcal and right lateral ventricle atrial region effacement.
 
Initial exam: Oriented x 4, +Dense left sided hemispatial and sensory neglect. Following commands, strength 2/5 on the left. Sensation intact to light touch on right; intact to painful peripheral stimulation bilaterally.
Following stabilization and monitoring, she was admitted to inpatient rehabilitation. Prior to therapy she reported to her care team that her chronic neuropathy resolved, stating “We had a no-foot-touching policy for years, but now my husband gives the best foot massages.”

Discussions: Central pain arises from injury to the somatosensory pathway, including the spinal cord, thalamus, and sensory cortex. In this case, chronic pain from thoracic demyelinating lesions resolved following right hemispheric hemorrhage. We hypothesize that parietal lobe disruption altered cortical pain processing, suppressing perception bilaterally. Postulated right hemisphere lateralization of pain associated networks may explain this global effect (i.e. bilateral pain reduction).

Conclusions: To our knowledge, this is the first case demonstrating resolution of chronic multiple sclerosis associated central neuropathic pain following stroke.