Department of Neurology, Toho University Omori Medical Center, Tokyo, Japan.
Department of Neurology, Toho University Omori Medical Center, Tokyo, Japan.
J Stroke Cerebrovasc Dis. 2014 Jan;23(1):187-90. doi: 10.1016/j.jstrokecerebrovasdis.2012.11.010. Epub 2012 Dec 21.
A 64-year-old obese man developed hypesthesia in the left arm and leg. Neurological examination revealed decreased senses of pain, touch, and temperature in the left face, arm, trunk, and leg. Remaining functions were normal. Electrocardiogram showed atrial fibrillation. Somatosensory-evoked potentials using the stimulation in the median nerve were normal on both sides. Brain magnetic resonance imaging revealed acute infarction in the right parietal operculum and insula. There were no pathognomonic lesions in the postcentral gyrus, the thalamus, or the brain stem. Cardioembolic operculo-insular infarction was diagnosed. Diffusion tensor tractography map displayed the thalamocortical projections to the primary and the secondary somatosensory cortex (S2). These radiological findings supported that the operculo-insular lesion could disrupt the thalamo-S2 pathway. Thus, the thalamocortical disconnection between the thalamus to the S2 could cause superficial hemisensory dysfunction in the present patient.
一位 64 岁肥胖男性出现左上肢和下肢感觉迟钝。神经检查显示左侧面部、上肢、躯干和下肢的痛觉、触觉和温度觉减退。其余功能正常。心电图显示心房颤动。正中神经刺激体感诱发电位双侧正常。脑磁共振成像显示右侧顶叶脑岛急性梗死。后中央回、丘脑或脑干无特征性病变。诊断为心源性脑岛顶叶梗死。弥散张量纤维束成像显示丘脑皮质投射到初级和次级体感皮层（S2）。这些影像学发现支持脑岛顶叶病变可能破坏丘脑-S2 通路。因此，丘脑至 S2 的丘脑皮质连接中断可能导致本例患者出现浅表半侧感觉功能障碍。
