Oishi Naoya, Udaka Fukashi, Kubori Tamotsu, Nishinaka Kazuto, Kameyama Masakuni
Department of Neurology, Sumitomo Hospital, 15-3-20 Nakanoshima, Kita-ku, Osaka 530-0005, Japan.
No To Shinkei. 2003 Jul;55(7):595-8.
We report a 65-year-old woman with sudden onset of paresthesia on the left side of the lip and left thumb. Neurological examinations did not demonstrate any disturbance of higher brain function or motor function except for subjective thermohyperesthesia of the left thumb. Brain MRI demonstrated a small high intensity lesion on T2-weighted images (T2 WI) and diffusion-weighted images (DWI) in the right anterior precentral gyrus. She was diagnosed with cerebral infarction presenting with pure cheiro-oral syndrome (COS). Her neurological symptoms were completely abolished 4 or 5 days later. The thalamus is the region responsible for COS in the majority of cases while reports that a cortical infarction causes COS are rare, because it is difficult to show a small cortical lesion on CT or conventional T2WI. DWI is superior to T2 WI in discriminating between acute and chronic ischemic lesions as well as in detecting small cortical lesions adjacent to the cerebrospinal fluid. In this patient, the lesion was vaguely hyperintense on T2 WI and difficult to differentiate from an artifact caused by cerebrospinal fluid. The precentral gyrus infarction detected on DWI was thought to cause COS in this patient. Not only lesions of the postcentral gyrus as a primary sensory cortex but also those of the precentral gyrus or opercula causing COS were described in previous reports, indicating that the hand and mouth sensory areas may be widely distributed. Cortical mapping studied by electrical stimulation through subdural grid electrodes also supports this finding. Further examination of the relation between neurological symptoms and localization on MR images such as DWI is needed to clarify the distribution of the sensory cortex.
我们报告了一位65岁女性，其左侧唇部和左手拇指突然出现感觉异常。神经学检查未发现除左手拇指主观热感觉过敏外的任何高级脑功能或运动功能障碍。脑部MRI在右侧中央前回前部的T2加权图像（T2WI）和弥散加权图像（DWI）上显示出一个小的高信号病变。她被诊断为表现为纯口手综合征（COS）的脑梗死。4或5天后，她的神经症状完全消失。在大多数情况下，丘脑是导致COS的区域，而关于皮质梗死导致COS的报道很少，因为在CT或传统T2WI上很难显示小的皮质病变。DWI在区分急性和慢性缺血性病变以及检测与脑脊液相邻的小皮质病变方面优于T2WI。在该患者中，病变在T2WI上呈模糊的高信号，难以与脑脊液引起的伪影区分开来。在DWI上检测到的中央前回梗死被认为是该患者COS的病因。先前的报道不仅描述了作为主要感觉皮层的中央后回病变，还描述了导致COS的中央前回或岛盖病变，这表明手和口的感觉区域可能广泛分布。通过硬膜下栅格电极进行电刺激研究的皮质图谱也支持这一发现。需要进一步检查神经症状与MR图像（如DWI）上的定位之间的关系，以阐明感觉皮层的分布。
