Pain as the first manifestation of an acute ischemic parietal stroke: A case report

Sudden-onset neurological deficit (paresis, numbness, aphasia, etc.) is the most common form of presentation of ischemic stroke, although sometimes it can manifest with positive symptoms or signs such as limb-shaking transient ischemic attack. Neuropathic central pain as the first manifestation of an acute stroke is rare.1 Central pain has been traditionally classified according to the location of the lesion in infra-thalamic, thalamic, or supra-thalamic, however. Different studies have shown that stimulation on the superior portion of the primary somatosensory cortex of the parietal lobe, the pre- and postrolandic sulci and the parietal operculum can trigger pain in the contralateral hemibody.2 We present a patient with acute cerebral infarction in the parietal cortex who presented with contralateral limb pain as the form of presentation of an acute ischemic stroke. An 82-year-old woman was admitted to our hospital due to sudden-onset severe pain in the left lower limb. She had a history of diabetes mellitus, hypertension, dyslipidemia, hypothyroidism, right saphenectomy, dilated cardiomyopathy, and mild cognitive impairment. Sharp pain, rated using the numerical rated scale as 10/10, and located on the dorsum of the left foot. The patient had been assisted at home during pain-onset, and was transferred to the emergency department. At admission, pain had improved to 6/10 grade, but she presented a left distal left leg weakness rated with the Medical Research Council Manual Muscle Testing scale as 4/5. On examination, pedal and posterior tibial pulses were palpable and symmetrical rated as 3+ grade. Pinprick, light touch, and temperature sensation were decreased on her left leg as same as her leg foot. Lasegue's sign was absent. Vibratory sensation was diminished on her left food, but position sense was normal.