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.