Supplementary material (for online only publication)
Supplementary Figure 1.
Example lesion identifications for a control and a central post-stroke pain patient. (A)
Atlas of the thalamus in Hirai and Jones nomenclature. (B) MRI of a control subject, (C)
Lesion identified according to MRI of control subject, (D) Lesion of control subject with
atlas overlay (lesion in red, identified with arrow), (E) MRI of central post-stroke pain
patient (F) Lesion identified according to MRI of central post-stroke pain patient, (G)
Lesion of central post-stroke pain patient with atlas overlay (lesion in red, identified with
arrow).
Supplementary Table 1. Clinical characteristics of the patients suffering from central
post-stroke pain of thalamic origin. The lesioned thalamic nuclei are tabulated according
to the nomenclature of Hirai and Jones 1989. Abbreviations: LGN lateral geniculate;
MGN medial geniculate; VA ventral anterior; VAS visual analogue pain score; VL
ventral lateral; VP ventral posterior.
patient/age/sex
lesion type
pain
onset
symptoms
/
other symptoms
and
current pain
medication
intensity
Lesioned
nuclei
thalamic
(atlas-based
computed
determination)
with
size of the lesion within
each nucleus
1) 62y, female
Hemorrhagic
10
month
after
infarction of the
stroke:
right thalamus and
(VAS: 2/10) of the left
basal ganglia
lower limb; left-sided
burning
the
pain
Hemiplegia of the left
Gabapentin,
body side
Sertraline
Pulvinar: 824 mm3
VP: 447 mm3
Central Nuclei: 185 mm3
Medial Dorsal: 131 mm3
hemihypesthesia to light
touch and vibration
Lateral Posterior: 41 mm3
VL: 32 mm3
MGN: 22 mm3
2) 72y, male
Ischemic infarction
Immediate pain onset
Impaired
of the left thalamus
with stroke:
perception of the left
burning
pain (VAS: 7/10) of the
left
body
side
dysaesthesias
allodynia
with
and
thermal
Opioids,
Lorazepam
Pulvinar: 633 mm3
VP: 209 mm3
body side
MGN: 167 mm3
LGN: 57 mm3
Central Nuclei: 27 mm3
2
3) 61y, female
Ischemic infarction
Developed
promptly
Dystonia of the left
Phenytoin,
in the territory of
after the stroke: burning
arm, hemiplegia of
Carbamazepine,
the right posterior
pain (VAS: 10/10) of
the left body site
Lorazepam,
cerebral
the left upper arm and
artery
including
the
thalamus
shoulder;
Tilidine
sensations,
hypaesthesia
touch
and
to
Lateral Posterior: 106 mm3
VP: 106 mm3
MGN: 67 mm3
paradoxical
heat
Pulvinar: 1491 mm3
LGN: 44 mm3
light
Central Nuclei: 34 mm3
pinprick
stimuli of left upper
Lateral Dorsal: 33 mm3
extremity
Medial Dorsal: 25 mm3
VL: 2 mm3
4) 64y, male
Ischemic infarction
5
of
ischemic
the
right
thalamus
weeks
continous
after
the
event:
Secondary parkinson
syndrom
and
VP: 80 mm3
Clonazepam,
MGN: 62 mm3
Gabapentin,
Pulvinar: 58 mm3
Fentanyl,
Medial Dorsal: 19 mm3
Lamotrigine,
Lateral Posterior: 15 mm3
Pregabalin
VL: 5 mm3
burning
hemibody pain (VAS:
5/10)
Amitriptyline,
left-sided
hemihypaesthesia
to
light touch
Central Nuclei: 4 mm3
5) 50y, male
Ischemic
1 year after the ischemic
Right
infarctions
event:
impairment
of
the
right
posterior part of
burning,
right mesial
temporal lobe
of
squeezing and pressing
position
left
intentional and action
hemibody
pain
(VAS: 7–8/10) sparing
the thalamus and
sided
the
face;
fluctuating,
initially
Amitriptyline,
Pulvinar: 622 mm3
Carbamazepine,
VP: 174 mm3
Sodium-
MGN: 74 mm3
sense,
valproate,
tremor, dystonic and
choreoathetoid
Tizanidine
Central Nuclei: 8 mm3
Lateral Posterior: 14 mm3
later
constant and aggravated
movements
during movements and
touch;
left-sided
hypalgesia, dysaesthesia
and allodynia
3
6) 77y, female
Hemorrhagic
Immediate pain onset
infarction of the
with stroke: Left sided
Citalopram,
right thalamus
burning hemibody pain
Tolperisone
(VAS
7/10)
Paresis of the left leg
Gabapentin,
VP: 200 mm3
Lateral Posterior: 111 mm3
and
hemihypaesthesia
Pulvinar: 1019 mm3
Medial Dorsal: 66 mm3
to
light touch
Central Nuclei: 33 mm3
MGN: 24 mm3
Lateral Dorsal: 10 mm3
VL: 3 mm3
7) 60y, male
Ischemic infarction
affecting
the
posterior part of
3
months
after
the
Dysdiadochokinesia,
ischemic event: right
dysmetria.
hemibody:
quadrantanopsia
the left thalamus
continuous
and the border
and burning
cognitive
pain (VAS: 7/10), right-
deficit
zones
of
the
lacerating
posterior cerebral
sided paraesthesias,
artery
dysaesthesias
territory
bilaterally
Tilidine,
Pulvinar: 517 mm3
Mirtazapin
MGN: 172 mm3
Amitriptyline
VP: 119 mm3
Lamotrigine
Central Nuclei: 15 mm3
to the right, mild
LGN: 6 mm3
Medial Dorsal: 1 mm3
and
allodynia; hypaesthesia
to light touch, vibration
and pinprick stimuli of
left upper extremity
8) 65y, male
Ischemic infarction
5
of
ischemic
the
thalamus
right
weeks
(VAS
after
event:
7/10)
of
the
Dyskinesia,
Pain
hypaesthesia
the
complete left body site
for
9
hypaesthesia
years;
to
light
Lamotrigine
and
Medial Dorsal: 636 mm3
Pulvinar: 216 mm3
pallanaesthesia of the
left arm
MGN: 72 mm3
Anterior Nuclei: 43 mm3
Lateral Dorsal: 34 mm3
touch
Lateral Posterior: 9 mm3
LGN: 3 mm3
4
Central Nuclei: 2 mm3
9) 72y, male
ischemic infarction
After 3 years: slowly
Hemihypesthesia
in the territory of
developing pain (VAS
the right body site
the left posterior
8/10) of almost the
Zolpidem,
cerebral artery
complete
Gabapentin
site;
right
of
Tetrazepam,
body
hypaesthesia
Amitryptiline,
Pulvinar: 381 mm3
Lateral Posterior: 69 mm3
VP: 64 mm3
to
light touch
10) 72y, male
ischemic infarction
of the left thalamus
Initially
Initially
hemihypaesthesia of the
right
body
side,
consecutive
hemihypesthesia
the right body site
Duloxetine,
of
Pregabalin
VP: 205 mm3
VL: 135 mm3
Central Nuclei: 42 mm3
development of
Pulvinar: 10 mm3
electrifying strong and
Medial Dorsal: 4 mm3
permanent pain (VAS
MGN: 1 mm3
8/10) of the right hand
over
weeks
with
mechanical
hyperalgesia
5
Supplementary Table 2. Clinical characteristics of the patients with thalamic lesion but
no central post-stroke pain of thalamic origin. The lesioned thalamic nuclei are tabulated
according to the nomenclature of Hirai and Jones 1989.
Abbreviations: VA ventral anterior; VL ventral lateral; VP ventral posterior;
patient/age/sex
lesion type
pain symptoms
other symptoms
current
pain
medication
Lesioned
nuclei
thalamic
(atlas-based
computed
determination)
with
size of the lesion within
each nucleus
1) 72y, male
Ischemic infarction
none
Right-sided hemichorea
none
of the left thalamus
Lateral Dorsal: 103 mm3
Central Nuclei: 15 mm3
Anterior Nuclei: 1 mm3
2) 61y, male
Ischemic infarction
none
of the left thalamus
Hypaesthesia of the left
none
hemibody
Pulvinar: 206 mm3
VP: 114 mm3
Central Nuclei: 72 mm3
VL: 17 mm3
Lateral Posterior: 5 mm3
Medial Dorsal: 4 mm3
3) 69y, male
Ischemic infarction
none
Vertigo
none
of the left thalamus
Medial Dorsal: 23 mm3
VL: 10 mm3
Central Nuclei: 9 mm3
4) 54y, female
Ischemic infarction
none
Transient
none
Pulvinar: 527 mm3
6
of the right thalamus
VP: 172 mm3
hemihypesthesia of the
left body side
Lateral Posterior: 72 mm3
Medial Dorsal: 53 mm3
Central Nuclei: 44 mm3
VL: 14 mm3
5) 66y, male
Ischemic infarction
none
Left-sided hemiparesis
none
of the right thalamus
VL: 237 mm3
Medial Dorsal: 176 mm3
Central Nuclei: 71 mm3
VP: 33 mm3
VA: 1 mm3
6) 51y, male
Ischemic infarction
none
of the right thalamus
Discrete
left-sided
none
hypaesthesia
Pulvinar: 182 mm3
Lateral Posterior: 104 mm3
VP: 28 mm3
7) 64y, female
Ischemic infarction
none
of the left thalamus
Right-sided
perioral
none
paraesthesia,
VL: 152 mm3
VP: 50 mm3
coordination deficits of
the
right
hand
Central Nuclei: 23 mm3
and
weakness of the right leg
8) 53y, male
Ischemic infarction
none
Clinically asymptomatic
none
of the left thalamus
Central Nuclei: 54 mm3
Medial Dorsal: 19 mm3
VP: 13 mm3
VL: 8 mm3
9) 52y, male
Ischemic infarctions
of the right thalamus
and right midbrain
none
Diplopia,
latent
hemiparesis of the right
none
Medial Dorsal: 109 mm3
VL: 36 mm3
arm
Central Nuclei: 31 mm3
VA: 8 mm3
7
VP: 2 mm3
10) 64y, female
Ischemic infarction
none
Temporary
left-sided
of the right thalamus
hemihypaesthesia,
(4 y prior to study)
lasting
for
about
none
VP: 16 mm3
6
months
8