ORIGINAL RESEARCH article
Front. Neurol.
Sec. Neurorehabilitation
White Matter Tracts Involved in Complex Regional Pain Syndrome After Subcortical Stroke
Provisionally accepted
- 1Asan Medical Center Department of Rehabilitation, Seoul, Republic of Korea
- 2Department of Electronics and Information Engineering, Korea University, Sejong, Republic of Korea
- 3Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea
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Post-stroke complex regional pain syndrome (CRPS) is a challenging complication that impairs recovery during stroke rehabilitation, particularly during the subacute phase. Despite its clinical significance, the neural substrates underlying post-stroke CRPS, specifically following subcortical stroke, remain unclear. This retrospective observational study included 40 patients with first-ever subcortical stroke diagnosed with CRPS via a three-phase bone scan, and 40 propensity score–matched controls without CRPS. White matter tract involvement was analyzed using atlas-based lesion mapping and voxel-based lesion overlap analysis in patients with available clinical scores and imaging findings (magnetic resonance imaging or computed tomography). Between-group comparisons of white matter tract involvement were conducted with false discovery rate (FDR) correction. Clinical characteristics were similar between groups, except for fewer CRPSpatients with a shoulder flexor manual muscle test score ≥3. Lesion overlap with the cingulum in the cingulate gyrus was significantly greater in the CRPS group (F = 5.197, FDR-adjusted P = 0.040). Although the forceps minor showed marginal significance before correction, it was non-significant after adjustment. These findings raise the possibility that the cingulate cortex, particularly the cingulum, may contribute to post-stroke CRPS pathophysiology. However, further confirmation in larger prospective studies is needed.
Keywords: Stroke, subcortical, white matter tract, complex regional pain syndrome, Atlas-based lesion overlapping analysis
Received: 05 Sep 2025; Accepted: 10 Nov 2025.
Copyright: © 2025 Cha, Jeong, CHO, Chang, Paik, Kim and Han. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Won-Seok Kim, wondol77@gmail.com
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