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nbme21/Block 4/Question#49 (reveal difficulty score)
A 76-year-old man comes to the physician ...
Left thalamus🔍,📺

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submitted by tinydoc(250),
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pcaiNehortu ainP arfet sokert is naelrtc osPt osetrk pain Smyenord

ueascd by naatcrearllto ailahctm lesonis

g.P 045 1A9F

chandlerbas  agreed! more specifically damage to the VPL +6  
docshrek  Pg. 403 FA 19. +  
baja_blast  Both commenters above got the page wrong; it's FA 2019 p. 503. +5  
teepot123  looooool ^ what were the odd of both being wrong +  
mumenrider4ever  Pg. 515 FA 2020 +  
bbr  503 in 2019 Interesting that its seen in 10% of strokes. Starts with allodynia ---> neuropathic pain. +  
skonys  Underlying Mech From Wiki: The thalamus is generally believed to relay sensory information between a variety of subcortical areas and the cerebral cortex. It is known that sensory information from environmental stimuli travels to the thalamus for processing and then to the somatosensory cortex for interpretation. The final product of this communication is the ability to see, hear or feel something as interpreted by the brain. Dejerine–Roussy syndrome (Thalamic Pain Syndrome) most often compromises tactile sensation. Therefore, the damage in the thalamus causes miscommunication between the afferent pathway and the cortex of the brain, changing what or how one feels +  

submitted by neonem(588),
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I tnikh uoy anc konw ahtt isth si a aitlahmc erktso rethra tnha cotlrcai saeuebc a acroiclt reskto ruoncrigc olny in hte teacolpntsr gysru mirpa(ry nrssoey )otrxce nda vlvingnoi eht etnrei uloscuunhm hwottiu eftcganfi het rayben elrarectnp gruys py(raimr ormot rx)tceo si veyr ylei.lunk

sahusema  Ya I think this question is trying to test your knowledge between a cortical lesion and a subcortical lesion. +1  
cienfuegos  Central Stroke Syndrome: Neuropathic pain due to thalamic lesions. Initial paresthesias followed in weeks to months by allodynia (ordinarily painless stimuli cause pain) and dysesthesia on the contralateral side. Occurs in 10% of stroke patients. FA 2018 499 +4  

submitted by an1(6),

I had no idea this was central Stroke Syndrome. But got it right with this logic. Vibration (Posterior column) and pain (spinothalamic) both ultimately synapse in the VPL thalamus. Symptoms on the right side means that the lesion is contralateral in the brain due to decussation rules. so Left thalamus was the origin. Discussed in table FA'18 page 493