Cerebral lesions can cause dermatomal sensory deficit. The most commonly reported site is the medulla oblongata due to its well-separated sensory systems. Dermatomal sensory deficit that has developed after pontine infarctions have been reported in several cases, the majority of which involved the medial lemniscus. However, restricted spinothalamic sensory loss has rarely been reported in pontine infarctions. We report herein a patient who presented with dermatomal spinothalamic sensory deficits below the tenth thoracic level after pontine infarction.
Humans ; Infarction ; Medulla Oblongata ; Spinothalamic Tracts

No abstract available.
Accidental Falls* ; Craniocerebral Trauma* ; Head* ; Spinothalamic Tracts*

No abstract available.
Accidental Falls* ; Craniocerebral Trauma* ; Head* ; Spinothalamic Tracts*

Avellis syndrome is a clinical disorder characterized by ipsilateral paralysis of palate, larynx, and vocal cord paralysis and contralateral hemianesthesia. The syndrome is usually due to lesion of medulla oblongata. Involeved structures are nucleus ambiguus, lateral spinothalamic tract, and descending sympathetic fibers. We present 2 cases of Avellis syndrome with MRI findings, which showed infarction of right-sided upper medulla oblongata.
Adrenergic Fibers ; Infarction ; Larynx ; Magnetic Resonance Imaging ; Medulla Oblongata ; Palate ; Paralysis ; Spinothalamic Tracts ; Vocal Cord Paralysis

Pure sensory stroke (PSS), first described by Fisher in 1965, is a clinical condition characterized by numbness and paresthesia of the face, arm and trunk on one side, in absence of other neurologic deficit. PSS could arise anywhere along the sensory system from the cerebral cortex to the medulla. The authors experienced 5 patients with PSS: one patient had a hemorrhage on the thalamocortical pathway including the internal capsule and the corona radiata. Two another had thalarnic lesions. The fourth had a pontine hemorrhage with perioral onionpeel distributed face sensor- involvement. And the last had a pontine lacune involving crossed trigeminothalamic tract and lateral spinothalamic tract.
Arm ; Cerebral Cortex ; Hemorrhage ; Humans ; Hypesthesia ; Internal Capsule ; Neurologic Manifestations ; Paresthesia ; Spinothalamic Tracts ; Stroke*

In rare cases restricted sensory deficits along the somatotopic topography of the spinothalamic tract can develop from a lateral medullary infarction. To our knowledge, isolated dermatomal sensory deficit as a single manifestation of a lateral medullary infarction has not been reported previously. A 58-year-old man presenting with sudden left-sided paresthesia complained of sensory deficit of pain and temperature below the left T4 sensory level without other neurologic deficits. Diffuse- and T2-weighted magnetic resonance imaging (MRI) of the brain showed high signal intensities in the right lower medulla oblongata, whereas thoracic-spine MRI and somatosensory evoked potentials produced normal findings.
Brain ; Evoked Potentials, Somatosensory ; Humans ; Infarction* ; Magnetic Resonance Imaging ; Medulla Oblongata ; Middle Aged ; Neurologic Manifestations ; Paresthesia ; Spinothalamic Tracts

Central pain, a neuropathic pain caused by an injury or dysfunction of the central nervous system, is a common, annoying sequela of mild traumatic brain injury (mTBI). Clarification of the pathogenetic mechanism of central pain is mandatory for precise diagnosis, proper management, and prognosis prediction. The introduction of diffusion tensor imaging allowed assessment of the association of the central pain and injury of the spinothalamic tract (STT), and traumatic axonal injury (TAI) in mTBI. In this review, 6 diffusion tensor tractography studies on central pain due to TAI of the STT in patients with mTBI are reviewed. The diagnostic approach for TAI of the STT in individual patients with mTBI is discussed, centering around the methods that these studies employed to demonstrate TAI of the STT.
Axons* ; Brain Concussion ; Brain Injuries* ; Central Nervous System ; Diagnosis ; Diffusion ; Diffusion Tensor Imaging ; Humans ; Neuralgia ; Prognosis ; Spinothalamic Tracts*

Cervical cordotomy via anterior approach without bone graft which is a modified Cloward's method is an effective and simple means of relieving of intractable pain with minimal destruction of bone lower morbidity and mortality. This method consists of an anterior surgical approach to the ventral surface of the cervical cord through a simple discectomy. A transverse incision in the dura mater gives excellent exposure permitting incision of the spinothalamic tracts under direct vision. For bilateral pain both incision are made at the same level of the cord without causing impairment of motor function of the lower extremities or bowel and bladder. This procedure has also many advantages and disavantages as follows ; 1. Cervical cordotomy by the this procedure has a much lower morbidity and fewer complications than the conventional procedure by laminectomy. 2. A more complete section of the spinothalamic tract is possible under direct vision. 3. A differential section of the tract with sparing of sensation in non-painful areas is possible by this procedure. 4. An incidence of the cord trauma can be minimized because the incision is possible without distorsion and traction of the cord during the operation. 5. This procedure without bone graft is simpler than original Cloward's method. 6. An water-tight closure of the dura is difficult but successful results are obtained by using a gelfoam. 7. This procedure above the level of the C3-4 interspace is difficult but possible. 8. A relief of pain below the level of the T3 dermatome is available and there is no good operative candidate when the brachial plexus is involved.
Brachial Plexus ; Cordotomy* ; Diskectomy ; Dura Mater ; Gelatin Sponge, Absorbable ; Incidence ; Laminectomy ; Lower Extremity ; Mortality ; Pain, Intractable ; Sensation ; Spinothalamic Tracts ; Traction ; Transplants* ; Urinary Bladder

Complex regional pain syndrome (CRPS) type I in stroke patients is usually known to affect the hemiplegic upper limb. We report a case of CRPS presented in an ipsilesional arm of a 72-year-old female patient after an ischemic stroke at the left middle cerebral artery territory. Clinical signs such as painful range of motion and hyperalgesia of her left upper extremity, swollen left hand, and dystonic posture were suggestive of CRPS. A three-phase bone scintigraphy showed increased uptake in all phases in the ipsilesional arm. Diffusion tensor tractography showed significantly decreased fiber numbers of the corticospinal tract and the spinothalamic tract in both unaffected and affected hemispheres. Pain and range of motion of the left arm of the patient improved after oral steroids with a starting dose of 50 mg/day.
Aged ; Arm ; Complex Regional Pain Syndromes ; Diffusion ; Diffusion Tensor Imaging ; Female ; Hand ; Humans ; Hyperalgesia ; Middle Cerebral Artery ; Posture ; Pyramidal Tracts ; Radionuclide Imaging ; Range of Motion, Articular ; Spinothalamic Tracts ; Steroids ; Stroke ; Upper Extremity

Loss of pain and temperature sensation due to lateral medullary infarction are well known and classically involve the ipsilateral side of the face and the lower part of the body on the controlateral side. This pattern of sensory loss below a certain level on the trunk, usually a sign of spinal cord disease, may also appear following a lesion in the lateral medullar, due to damage to the spinothalamic tract. A 72-year-old hypertensive man developed sudden dizziness, headache, and gait ataxia. On neurologic examination, he had left limb and gait ataxia. Five days later he noted loss of pain and temperature sensation on the right leg and trunk with a sensory level at T4 with preservation of touch, vibration, and joint position sense in all limbs. Brain MRI showed a small infarct in the left lower lateral medulla. Brain MR angiography showed stenosis of the right proximal carotid artery, left distal vertebral artery, and mid-basilar artery. We report a case of sensory defects with a sensory level on the trunk that occured as the result of lesion of the lower lateral medulla.
Aged ; Angiography ; Arteries ; Brain ; Carotid Arteries ; Constriction, Pathologic ; Dizziness ; Extremities ; Gait Ataxia ; Headache ; Humans ; Infarction ; Joints ; Leg ; Magnetic Resonance Imaging ; Medulla Oblongata ; Neurologic Examination ; Proprioception ; Sensation ; Spinal Cord Diseases ; Spinothalamic Tracts ; Vertebral Artery ; Vibration