Prediction of type 1 complex regional pain syndrome with the presence of diaschisis in hemiplegic supratentorial stroke patients.

BACKGROUND

Hemiplegic shoulder pain (HSP) and complex regional pain syndrome type 1 (CRPS) are common post-stroke complications. Crossed cerebellar diaschisis (CCD) has been associated with poor motor outcomes, but its relationship with CRPS is unclear.

OBJECTIVES

To investigate whether CCD on brain perfusion SPECT is associated with CRPS type 1 in subacute unilateral supratentorial stroke.

METHODS

We retrospectively analyzed 148 patients who underwent brain SPECT. CCD was defined as a cerebellar asymmetry index (AI) ≥10%. CRPS was diagnosed using the Budapest criteria and confirmed by three-phase bone scintigraphy. Multivariable logistic regression analyses were performed with pre-specified covariates.

RESULTS

CCD was present in 65 patients (43.9%), and CRPS occurred in 40 (27.0%). CRPS incidence was higher in patients with CCD (46.2% vs. 12.0%; relative risk 3.83, 95% CI 2.02-7.25). In adjusted analyses, higher AI (OR 1.11, 95% CI 1.04-1.18) and CCD (OR 3.76, 95% CI 1.50-9.41) were associated with increased CRPS risk, while higher proximal MMT was protective (OR 0.27, 95% CI 0.15-0.48).

CONCLUSIONS

CCD is associated with increased CRPS risk in subacute stroke. Early identification on SPECT may aid monitoring and intervention.