What could be causing these post stroke symptoms?

Tamalac asked...

My mother had a stroke in April 2009 in the thalamus area, affecting the right side of her body. She has since suffered from pain, often severe, on the right side of her body as well as her left arm. The arms seem to be affected the most and will feel hot to touch at times and her palms are sometimes red. She also has suffers from headaches with dizziness and nausea which the neurologist referred to as a migraine type syndrome? She also has difficulty swallowing. Although she can eat she's often too nauseated most of the time to do so. She also has aphasia which often becomes worse after headaches. Next week she will undergo a brain angioplasty and spinal tap. Doctors are not quite sure what is wrong with her because the stroke happened in what they call "Grand Central Station" of the brain and can cause many problems. My question is has anyone else had similar problems?? I just hate to see her suffer with no real answers yet. Any info would be helpful as we both just want her to get as well as possible.

Thanks, Tamala

Expert Answer

James Castle, M.D. is a neurologist at NorthShore University HealthSystem (affiliated with The University of Chicago) and an expert on strokes.

The thalamus is a very important part of the brain, and a stroke there can be quite debilitating.

First, with regard to the limb pain, this is very common after a thalamic stroke. It is similar to the phantom limb pain people complain about after a limb amputation - the body simply doesn't know how to interpret a lesion in the sensory neurons coming from the limb through the thalamus, and mis-interprets this as pain. In my experience, it is best treated with the medicines amitriptyline, nortriptyline, gabapentin, Lyrica, or possibly Cymbalta.

The headaches may also be from the stroke, and a headache disorder which started because of the stroke, and the above mentioned medications can be very helpful. Topiramate is another effective headache medicine, but you might find that it makes her speech problems a bit worse. I strongly agree with your doctors, however, on the need for a angiogram and a spinal tap - to make sure that there is nothing else at work, such as an autoimmune attack against the brain or the vessels in the brain.

The difficulty with speech is not uncommonly seen after a left thalamic stroke. It should improve slowly over time. Usually, the most improvements are seen over the first 3-6 months, and come very slowly.