Chen Wei-Hsi, Yang Tsung-Pei, Yin Hsin-Ling
Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Kaohsiung City, Taiwan.
Department of Clinical Forensic Medicine, Kaohsiung Medical University Hospital and College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.
J Clin Neurosci. 2017 May;39:130-132. doi: 10.1016/j.jocn.2016.12.033. Epub 2017 Jan 12.
Crossed cheiro-oral syndrome (CCOS) is characterized by crossed sensory disturbance confined to the unilateral perioral area and contralateral hand/finger(s). Although a few classical crossed sensory syndromes accurately predict brainstem or spinal involvement, the clinical significance of CCOS remains unclear. In this study, we analyzed the etiology, localization and outcome of CCOS patients. The results showed that ischemic stroke is the exclusive cause of CCOS. The location of responsible stroke is pertinent to the middle or upper level of the lateral medulla oblongata medial to the lateral sulcus. The vascular supply is from the vertebral artery or the posterior inferior cerebellar artery. Half of the CCOS patients progressed to Wallenberg's syndrome and complicated with disabled daily living. However, no patient died during the follow-up period. A larger size and dorsal extension of the infarction correlated with neurological deterioration. Therefore, CCOS is an independent clinical sign of medullary involvement. It strongly predicts involvement at the lateral medulla oblongata, especially the ischemic stroke, and neurological deterioration. A rapid evaluation of the infarction location and vascular status is suggested in cases of CCOS.
交叉性口手综合征（CCOS）的特征是交叉性感觉障碍，局限于单侧口周区域和对侧手/手指。尽管一些经典的交叉性感觉综合征能准确预测脑干或脊髓受累情况，但CCOS的临床意义仍不明确。在本研究中，我们分析了CCOS患者的病因、病变部位及预后。结果显示，缺血性卒中是CCOS的唯一病因。责任性卒中的部位与外侧沟内侧的延髓中上部相关。血管供应来自椎动脉或小脑后下动脉。半数CCOS患者进展为延髓背外侧综合征，并伴有日常生活功能障碍。然而，随访期间无患者死亡。梗死灶面积较大及向背侧扩展与神经功能恶化相关。因此，CCOS是延髓受累的独立临床体征。它强烈提示延髓外侧受累，尤其是缺血性卒中，以及神经功能恶化。对于CCOS患者，建议快速评估梗死部位和血管状况。
