The Nucleus Accumbens as a Potential Target for Central Poststroke Pain Grant W. Mallory, MD, Osama Abulseoud, MD, Sun-Chul Hwang, MD, PhD, Deborah A.

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The Nucleus Accumbens as a Potential Target for Central Poststroke Pain Grant W. Mallory, MD, Osama Abulseoud, MD, Sun-Chul Hwang, MD, PhD, Deborah A. Gorman, RN, Squire M. Stead, MD, PhD, Bryan T. Klassen, MD, Paola Sandroni, MD, PhD, James C. Watson, MD, Kendall H. Lee, MD, PhD Mayo Clinic Proceedings Volume 87, Issue 10, Pages 1025-1031 (October 2012) DOI: 10.1016/j.mayocp.2012.02.029 Copyright © 2012 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 1 A, Preoperative axial T2-weighted fluid-attenuated inversion recovery image showing an old right hemispheric infarct with cortical encephalomalacia and Wallerian degeneration in the right thalamus. B, Intraoperative photograph showing externalized leads. Test stimulation was performed on the first postoperative day. C, Microelectrode recordings from the ventralis caudalis of the thalamus (VC) (10-second strip) demonstrating spike activity to light touch (arrows) even though the patient had no conscious perception. D-F, Stereotactic planning for deep brain stimulation of the VC (D), nucleus accumbens (NAC) (E), and periventricular gray region (PVG) (F). The PVG and VC were targeted using the human brain atlas of Schaltenbrand and Wahren,12 and the NAC was targeted using stereotactic coordinates described by Schlaepfer et al.13 Targets are indicated by red dots. R = right. Mayo Clinic Proceedings 2012 87, 1025-1031DOI: (10.1016/j.mayocp.2012.02.029) Copyright © 2012 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 2 Postoperative (left) and preoperative (right) stereotactic magnetic resonance images for each target. A, Nucleus accumbens (NAC). B, Periventricular gray region (PVG). C, Ventralis caudalis of the thalamus (VC). T1-weighted coronal sequences are shown with the target highlighted with a red dot. Metal artifact for each electrode can be seen, demonstrating that electrodes were placed at intended targets. R = right. Mayo Clinic Proceedings 2012 87, 1025-1031DOI: (10.1016/j.mayocp.2012.02.029) Copyright © 2012 Mayo Foundation for Medical Education and Research Terms and Conditions