300 Section - Does structural integrity of white matter correlate with the post-stroke complex regional pain syndrome?

Complex regional pain syndrome (CRPS) is a a debilitating post-stroke complication, particularly affecting the upper extremities. Although its mechanisms remain unclear, emerging evidence suggests involvement of motor and sensory pathway disruption. This study investigated the relationship between the structural integrity of the corticospinal tract (CST), spinothalamic tract (STT), and superior thalamic radiation (STR) and the development of post-stroke CRPS using diffusion tensor imaging (DTI). We hypothesized that patients with CRPS would show reduced white matter integrity compared with those without CRPS.

Design:

A retrospective analysis was performed using DTI from 20 stroke patients with CRPS, 20 without CRPS, and 20 healthy controls. Microstructural integrity of the CST, STT, and STR was assessed using fractional anisotropy (FA). Logistic regression models were constructed to identify factors associated with CRPS occurrence.

Results: In patients with post-stroke CRPS, the structural integrity of the CST, STT, and STR was significantly impaired compared to stroke patients without CRPS and healthy controls. The FA values of the CST, along with the presence of shoulder subluxation and lower functional independence, were identified as significant predictors of CRPS in multivariate analysis. Reduced FA in the CST was the most significant independent factor for CRPS development.

Conclusion:

Post-stroke CRPS is associated with reduced structural integrity in the CST, STT, and STR, with the CST playing a key role in its development. Additionally, shoulder subluxation and lower functional independence were found to contribute to CRPS. These findings provide insights into the involvement of motor and sensory pathways in post-stroke CRPS and highlight the importance of early detection and rehabilitation strategies targeting these factors.