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(Stroke. 2001;32:1696.)
© 2001 American Heart Association, Inc.

Letters to the Editor

Restricted Dissociated Sensory Loss in Lateral Medullary Infarction

Jong S. Kim, MD

Department of Neurology, Asan Medical Center, Seoul, South Korea

To the Editor:

In a recent article published in Stroke, Cerrato et al¹ described a patient with right lateral medullary infarction (LMI) who presented with abnormal spinothalamic sensation in the left arm and impaired dorsal column sensation in the right hand. Although this is an interesting observation, I have several concerns about this report.

First, the authors wrote that "dissociated sensory pattern involving upper limbs has not yet been reported." However, I previously described 3 patients who had ipsilateral dorsal column sensory impairment who had otherwise typical symptoms/signs of LMI.² Actually, one of them (case 3) showed exactly identical sensory pattern as described by Cerrato et al: dissociated sensory impairment limited to upper extremities. I suggested that involvement of the fibers at the nucleus gracilis/cuneatus or the crossing fibers toward the medial lemniscus may explain this sensory variant, a hypothesis again nearly identical with that raised by Cerrato et al. Therefore, their observation and hypothesis are not new.

Second, their Figure 3 was drawn as if the fibers from the nucleus cuneatus run ventrally and those from the nucleus gracilis dorsally into the contralateral medial lemniscus. Actually, it has been shown that in the medial lemniscus at the medulla level, sensory topography is arranged in such a way that the leg representation area is located ventrally and the arm representation area dorsally.³ Thus, the dorsal column sensory fibers are likely to decussate in a more complex manner than shown in Figure 3. Therefore, I think the lesion may have . . . [Full Text of this Article]

Paolo Cerrato, MD; Daniele Imperiale, MD; Marco Giraudo, MD; Chiara Baima, MD; Maria Grasso, MD; Leonardo Lopiano, MD Bruno Bergamasco, MD

Department of Neurology

Mauro Bergui, MD

Department of Neuroradiology, University of Torino, Torino, Italy