Hemisensory Syndrome: Difference between revisions
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*Incomplete hemisensory syndrome: includes variants such as cheiro-oral-cural syndrome, cheiro-oral syndrome, and isolated oral syndrome. | *Incomplete hemisensory syndrome: includes variants such as cheiro-oral-cural syndrome, cheiro-oral syndrome, and isolated oral syndrome. | ||
==Aetiology== | ==Aetiology and Associations== | ||
*Idiopathic | *Idiopathic | ||
*Migraine | *Migraine | ||
*Depression and anxiety | *Depression and anxiety | ||
*[[CRPS]]<ref>Rommel O, Gehling M, Dertwinkel R, Witscher K, Zenz M, Malin JP, Jรคnig W. Hemisensory impairment in patients with complex regional pain syndrome. Pain. 1999 Mar;80(1-2):95-101. doi: 10.1016/s0304-3959(98)00202-4. PMID: 10204721.</ref> | |||
*Pure sensory strokes | *Pure sensory strokes | ||
**Thalamus: ventral posterior nucleus which interconnects with the primary somatosensory cortex. | **Thalamus: ventral posterior nucleus which interconnects with the primary somatosensory cortex. | ||
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**Parietal lobe | **Parietal lobe | ||
**Corona radiata | **Corona radiata | ||
**Pons | **Pons: paramedian dorsolateral region | ||
==Clinical Features== | ==Clinical Features== | ||
Symptoms can be positive and/or negative. Positive symptoms are the presence of paraesthesias or dysaesthesias such as pins and needles, pricking, tightening, or burning. Negative symptoms are anaesthesia or hypoaesthesia. | Symptoms can be positive and/or negative. Positive symptoms are the presence of paraesthesias or dysaesthesias such as pins and needles, pricking, tightening, or burning. Negative symptoms are anaesthesia or hypoaesthesia.<ref name=":0" /> | ||
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In non-organic disease there is often an exact splitting at the midline. Organic disease can also have this pattern, however typically there is a paramedian distribution in this setting due to overlap of the intercostal nerves by 1-2cm.<ref name=":1" /> | |||
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Strokes of the ventral posterior nucleus is associated with contralateral hemisensory deficit involve mechanical, temperature, and noxious sensations.<ref name=":1" /> | |||
==Imaging== | ==Imaging== | ||
The standard modality is MRI brain which should include diffusion weighted images. An attenuation of apparent diffusion coefficent is consistent with ischaemic stroke. | The standard modality is MRI brain which should include diffusion weighted images. An attenuation of apparent diffusion coefficent is consistent with ischaemic stroke. | ||
Stroke was the cause for 3% in one study,<ref>{{#pmid:12876246}}</ref>, and 22% in another study.<ref>{{#pmid:33906637}}</ref> In the later study, symptom onset of under 24 hours was the strongest predictor of ischaemic stroke (OR 31.4). A history of smoking (OR 7.3) and to a lesser extent older age (OR 1.14) was also more common in those with ischaemic stroke. | Stroke was the cause for 3% in one study,<ref name=":1">{{#pmid:12876246}}</ref>, and 22% in another study.<ref name=":0">{{#pmid:33906637}}</ref> In the later study, symptom onset of under 24 hours was the strongest predictor of ischaemic stroke (OR 31.4). A history of smoking (OR 7.3) and to a lesser extent older age (OR 1.14) was also more common in those with ischaemic stroke. | ||
==References== | ==References== | ||
[[Category:Neurology]] | [[Category:Neurology]] |
Revision as of 08:33, 19 August 2021
The hemisensory syndrome refers to having an altered sensation on one side of the body. There is no weakness, homonymous hemianopia, aphasia, agnosia, or apraxia.
Classification
- Complete hemisensory syndrome: affects the entire face, arm, and leg. The trunk may or may not be involved.
- Incomplete hemisensory syndrome: includes variants such as cheiro-oral-cural syndrome, cheiro-oral syndrome, and isolated oral syndrome.
Aetiology and Associations
- Idiopathic
- Migraine
- Depression and anxiety
- CRPS[1]
- Pure sensory strokes
- Thalamus: ventral posterior nucleus which interconnects with the primary somatosensory cortex.
- Internal capsule: posterior quarter of the posterior limb where the sensory tracts without motor fibres are found.
- Parietal lobe
- Corona radiata
- Pons: paramedian dorsolateral region
Clinical Features
Symptoms can be positive and/or negative. Positive symptoms are the presence of paraesthesias or dysaesthesias such as pins and needles, pricking, tightening, or burning. Negative symptoms are anaesthesia or hypoaesthesia.[2]
In non-organic disease there is often an exact splitting at the midline. Organic disease can also have this pattern, however typically there is a paramedian distribution in this setting due to overlap of the intercostal nerves by 1-2cm.[3]
Strokes of the ventral posterior nucleus is associated with contralateral hemisensory deficit involve mechanical, temperature, and noxious sensations.[3]
Imaging
The standard modality is MRI brain which should include diffusion weighted images. An attenuation of apparent diffusion coefficent is consistent with ischaemic stroke.
Stroke was the cause for 3% in one study,[3], and 22% in another study.[2] In the later study, symptom onset of under 24 hours was the strongest predictor of ischaemic stroke (OR 31.4). A history of smoking (OR 7.3) and to a lesser extent older age (OR 1.14) was also more common in those with ischaemic stroke.
References
- โ Rommel O, Gehling M, Dertwinkel R, Witscher K, Zenz M, Malin JP, Jรคnig W. Hemisensory impairment in patients with complex regional pain syndrome. Pain. 1999 Mar;80(1-2):95-101. doi: 10.1016/s0304-3959(98)00202-4. PMID: 10204721.
- โ 2.0 2.1 Koh et al.. Hemisensory syndrome: Hyperacute symptom onset and age differentiates ischemic stroke from other aetiologies. BMC neurology 2021. 21:179. PMID: 33906637. DOI. Full Text.
- โ 3.0 3.1 3.2 Toth. Hemisensory syndrome is associated with a low diagnostic yield and a nearly uniform benign prognosis. Journal of neurology, neurosurgery, and psychiatry 2003. 74:1113-6. PMID: 12876246. DOI. Full Text.