Hemisensory Syndrome

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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
• 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.

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.

Strokes of the ventral posterior nucleus is associated with contralateral hemisensory deficit involve mechanical, temperature, and noxious sensations.

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,, and 22% in another study. 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.