Hemisensory Syndrome
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][2][3]
- Fibromyalgia[4]
- Myaesthenia gravis (case report)[5]
- Pure sensory strokes[6]
- 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.[6]
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.[7]
Strokes of the ventral posterior nucleus is associated with contralateral hemisensory deficit involve mechanical, temperature, and noxious sensations.[7]
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,[7], and 22% in another study.[6] 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 Drummond PD, Finch PM, Birklein F, Stanton-Hicks M, Knudsen LF. Hemisensory disturbances in patients with complex regional pain syndrome. Pain. 2018 Sep;159(9):1824-1832. doi: 10.1097/j.pain.0000000000001280. PMID: 29787471.
- โ Drummond PD, Vo L, Finch PM. The Source of Hemisensory Disturbances in Complex Regional Pain Syndrome. Clin J Pain. 2021 Feb 1;37(2):79-85. doi: 10.1097/AJP.0000000000000893. PMID: 33136610.
- โ da Silva LA, Kazyiama HH, Teixeira MJ, de Siqueira SR. Quantitative sensory testing in fibromyalgia and hemisensory syndrome: comparison with controls. Rheumatol Int. 2013 Aug;33(8):2009-17. doi: 10.1007/s00296-013-2675-6. Epub 2013 Feb 3. PMID: 23377531.
- โ Marshall B, Sharma U, Benes-Lima L, Rossi FH. Hemisensory loss in myasthenia gravis. BMJ Case Rep. 2021 Mar 17;14(3):e237405. doi: 10.1136/bcr-2020-237405. PMID: 33731400; PMCID: PMC7978066
- โ 6.0 6.1 6.2 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 7.0 7.1 7.2 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.