Kim J S
Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, South Korea.
Stroke. 1994 Dec;25(12):2497-502. doi: 10.1161/01.str.25.12.2497.
Restricted acral sensory syndrome (RASS) after minor stroke most often manifests as a cheiro-oral syndrome. However, recent studies have described more varied patterns of RASS and also have reported that the degree of sensory symptoms may vary among individual digits. Until recently, however, there have been no reports in which sufficient numbers of patients were studied with detailed information on the symptomatic severity among individual digits.
In this report, I describe 30 patients presenting with RASS secondary to minor stroke. Computed tomographic scan and/or magnetic resonance imaging identified lesions in the lateral thalamus in 11, midbrain in 2, pontine tegmentum in 8, capsulo-corona radiata in 5, and frontoparietal subcortical-cortical areas in 4 patients. The patterns of RASS were cheiro-oral in 10, cheiro-oral-pedal in 8, cheiro-pedal in 4, restricted to palm and/or fingers in 7, and periotal-pedal in 1. Dominant involvement of upper lip, thumb, and index finger was frequent, especially in patients with thalamic and thalamocortical lesions. In patients with cortical-subcortical lesions, cheiro-oral or restricted finger involvements were observed, while the foot was spared. In patients with pontine lesions, bilateral RASS was occasionally observed, and the pattern of preponderant involvement of the first two digits was not apparent.
These patterns of RASS generally agree with the previously observed sensory topography of monkeys, and they support anatomic proximity of sensory fibers from acral parts of the body. However, other mechanisms such as differential vulnerability of generation of paresthesia in different body parts or a low-threshold concept based on disproportionately large representing areas for the acral parts of the body in the human sensory system may also be required to explain some of the clinical observations.
轻度卒中后出现的局限性肢体末端感觉综合征（RASS）最常表现为口手综合征。然而，最近的研究描述了RASS更多样化的表现形式，并且还报告说感觉症状的程度在各个手指之间可能有所不同。然而，直到最近，还没有关于对足够数量的患者进行研究并提供各个手指症状严重程度详细信息的报告。
在本报告中，我描述了30例继发于轻度卒中的RASS患者。计算机断层扫描和/或磁共振成像显示，11例患者病变位于丘脑外侧，2例位于中脑，8例位于脑桥被盖，5例位于放射冠，4例位于额顶叶皮质下 - 皮质区域。RASS的表现形式为口手综合征10例，口手 - 足综合征8例，手 - 足综合征4例，局限于手掌和/或手指7例，耳周 - 足综合征1例。上唇、拇指和示指受累最为常见，尤其是在丘脑和丘脑皮质病变的患者中。在皮质 - 皮质下病变的患者中，观察到口手或局限于手指的受累情况，而足部未受累。在脑桥病变的患者中，偶尔观察到双侧RASS，且前两位数字优势受累的模式不明显。
这些RASS的表现形式总体上与先前观察到的猴子感觉地形图一致，并且支持来自身体肢体末端部位的感觉纤维在解剖学上的邻近性。然而，可能还需要其他机制，如不同身体部位感觉异常产生的易感性差异，或基于人体感觉系统中身体肢体末端部位不成比例的大代表区域的低阈值概念，来解释一些临床观察结果。
