TRIAD OF SENSORY FINDINGS LOCALISES TO CORTEX- ANALYSIS OF 5 CASES
Journal Title: Journal of Evidence Based Medicine and Healthcare - Year 2018, Vol 5, Issue 7
Abstract
BACKGROUND A fifty-two-year-old man presented with acute onset right lower facial and ear numbness and facial weakness, after two weeks of the onset of symptoms. Examination revealed right central facial palsy, depressed corneal reflex and hemifacial sensory loss (mild over forehead, severe over lower cheek, jaw & pinna) Localization was proposed in brainstem Vs Cerebellopontine angle. MRI Brain revealed infarct in peri Rolandic area; four more patients had similar presentation over next few years. 1 Core findings were ipsilateral graded facial sensory impairment with central facial palsy, ear involvement & impaired corneal reflex. Four had spastic hand. Hypothesis- Cortical lesions can have LMN- like presentation; impairment of facial and external ear (pinna) sensations, and attenuated corneal reflex. MATERIALS AND METHODS Settings and Design- Patients presenting to the Neurology OPD with facial weakness and isolated sensory loss of face were admitted and evaluated with detailed neurological examination, including facial & ear sensations and corneal reflex; Stroke work up & MRI Brain with MRA was done. They were treated and kept under follow up. RESULTS Patients with post central gyrus infarct had uniformity in presentation, graded sensory loss over face, depressed corneal reflex & ear involvement, had uniformity in presentations and medical help seeking usually were delayed. Two had lower face (mandibular region) severely affected; while three had maxillary involvement. Spastic hand weakness was found in four. CONCLUSION Cortical lesions can produce LMN-like sensory phenomena, of face. Corneal reflex abnormality & ear involvement occur in cortical lesions. Ear representation is closer to lower face in sensory cortex. Four out of five patients had spastic hand in this series. Hence in spastic hand due to cortical lesions, triad of sensory findings should be specifically elicited.
Authors and Affiliations
Beena Vasanthy Vijayan, Gourisankar Peringattu Thankappan Nair, Vijayan Chandrathil Parameswaran Nair
Keywords
Related Articles
- EP ID EP454532
- DOI 10.18410/jebmh/2018/117
- Views 105
- Downloads 0
A STUDY OF ASCORBIC ACID CONCENTRATION IN THE AQUEOUS HUMOR AND INTRA OPERATIVE CHALLENGES DURING CATARACT SURGERY IN PATIENTS WITH PSEUDO EXFOLIATION AS
To compare the concentration of ascorbic acid in the aqueous humor and serum of cases of pseudoexfoliation and age and sex matched controls and to observe the intra operative challenges faced during cataract surgery in c...
MODIFIED BOYTCHEV PROCEDURE IS AN EFFECTIVE SURGICAL TREATMENT FOR RECCURRENT ANTERIOR DISLOCATION OF SHOULDER
Recurrent anterior dislocation of shoulder is a common orthopedic problem. The pathology is well known i.e. bank arts lesion, hill sachs lesion and capsular laxity. In the literature more than 150 types of surgeries were...
CLINICO-HAEMATOLOGICAL STUDY OF PANCYTOPENIA IN A TERTIARY CARE CENTRE
BACKGROUND Pancytopenia is one of the pathological manifestation resulting from various underlying disease processes affecting the bone marrow. Hence, bone marrow examination is the diagnostic tool to detect the underlyi...
A STUDY ON TIBIAL TORSION IN ADULT DRY TIBIA OF EAST AND SOUTH INDIAN POPULATION
BACKGROUND Rotational deformities of the lower limbs are very common. There is increasing evidence that abnormal torsion in the tibia is associated with severe knee and ankle arthritis. Primary knee osteoarthritis is a l...
VISUAL FIELD DEFECTS IN PATIENTS OF TUBERCULOSIS ON ETHAMBUTOL
BACKGROUND Ethambutol causes retrobulbar neuritis that is related to the dose and duration of treatment, hence we undertook a prospective study of optic nerve function in patients on ethambutol. MATERIALS AND METHODS Thi...