Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, Eberhard-Karls University Tübingen, Hoppe-Seyler Str. 3, 72076, Tübingen, Germany.
Department of Neuroradiology, Eberhard-Karls University Tübingen, Hoppe-Seyler Str. 3, 72076, Tübingen, Germany.
J Neurol. 2017 Oct;264(10):2158-2161. doi: 10.1007/s00415-017-8611-z. Epub 2017 Sep 11.
Spreading somatosensory symptoms appearing as Jacksonian sensory march are usually considered to be due to an epileptic seizure. We report on three cases in which these symptoms were caused by thalamic ischemia. Two patients presented with stereotypically recurring hemiparesthesias lasting 2-5 min that gradually spread from the face to the arm and leg on one side. A first cerebral magnetic resonance imaging including DWI was negative in both cases, whereas new thalamic infarctions appeared on repeated imaging when clinical symptoms remained. A third case with a thalamic ischemia did not show recurring events, but also presented with purely sensory spreading symptoms. In all three cases EEG and cardiovascular diagnostics revealed normal results. Pure sensory stroke has previously been described as a result of ischemia of the thalamus or the internal capsule presenting as a sudden onset hemisensory deficit, but spreading symptoms have rarely been reported. According to our observations, thalamic TIAs are an important differential diagnosis of somatosensory epileptic auras presenting with Jacksonian sensory march which require a different clinical management.
出现杰克逊感觉行军的躯体感觉症状通常被认为是癫痫发作引起的。我们报告了三例由丘脑缺血引起的此类症状。两名患者表现为刻板的反复发作性半侧感觉异常，持续 2-5 分钟，逐渐从面部向一侧的手臂和腿部扩散。在两种情况下，首次进行的包括 DWI 的脑部磁共振成像均为阴性，而当临床症状持续存在时，重复成像显示出现新的丘脑梗死。第三例丘脑缺血没有出现反复发作的事件，但也表现出单纯的感觉扩散症状。在所有三种情况下，脑电图和心血管诊断均显示正常结果。先前已有研究描述过丘脑或内囊缺血导致的单纯感觉性卒中，表现为突发的半侧感觉缺失，但传播症状很少有报道。根据我们的观察，丘脑 TIA 是出现杰克逊感觉行军的躯体感觉癫痫先兆的一个重要鉴别诊断，需要进行不同的临床管理。
