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Stroke, Vol 25, 2497-2502, Copyright © 1994 by American Heart Association
JS Kim
BACKGROUND: 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. SUMMARY OF REVIEW: 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. CONCLUSIONS: 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.
ARTICLES
Restricted acral sensory syndrome following minor stroke. Further observation with special reference to differential severity of symptoms among individual digits
Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, South Korea.
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