A hematoma location-based nomogram incorporating hematoma location, modified Graeb score, and body temperature showed AUCs of 0.852 and 0.870 in training and validation cohorts for predicting thalamic pain within 6 months after spontaneous thalamic hemorrhage.
Thalamic pain occurred in 27.87% of the training cohort and 38.21% of the validation cohort within 6 months after spontaneous thalamic hemorrhage.
A nomogram incorporating hematoma location, modified Graeb score (mGS), and body temperature demonstrated strong discriminative performance for predicting thalamic pain.
The association between hematoma location and thalamic pain appeared more pronounced at lower modified Graeb scores.
Among patients with thalamic pain, maximum NRS (Numeric Rating Scale) pain scores differed significantly across hematoma locations, with lateral bleeds showing the highest pain intensity.
Initial hematoma volume was not correlated with maximum NRS pain score among patients with thalamic pain.
This research suggests that after a spontaneous bleeding event in the thalamus (a deep brain structure involved in pain processing), a meaningful proportion of patients — roughly 28–38% in this study — go on to develop a chronic pain condition called thalamic pain within six months. The researchers developed a prediction tool called a nomogram using three readily available clinical features: where in the thalamus the bleeding occurred, how much blood entered the brain's ventricles (fluid-filled cavities), and the patient's body temperature. This tool performed well at identifying which patients were at higher risk for developing thalamic pain, with accuracy measures (AUC) of approximately 0.85–0.87. The study also found that the location of the bleed within the thalamus matters not just for predicting whether pain will develop, but also for how severe that pain will be. Patients with bleeding in the lateral (outer) portion of the thalamus reported the highest pain intensities. Importantly, the overall size of the initial bleed was not related to pain severity — meaning a larger hemorrhage does not necessarily mean worse pain. The relationship between bleed location and pain risk was especially strong in patients with less bleeding into the ventricles. This research suggests that routine information collected at hospital admission — specifically CT scan findings about bleed location and ventricular involvement, plus body temperature — could help clinicians identify which thalamic hemorrhage patients are most likely to develop chronic pain and potentially prioritize them for early pain management strategies. The findings support using hematoma location as a key factor in risk stratification, which could be practically implemented without requiring additional specialized testing.
Zhang X, Gao S, Shen Y, Hou T, Zhang J, Feng J, et al.. (2026). A hematoma location-based nomogram for individualized prediction of thalamic pain after spontaneous thalamic hemorrhage.. Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. https://doi.org/10.1007/s10072-026-09392-8