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Patterns of sensory abnormality in cortical stroke

Evidence for a dichotomized sensory system

From the Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea.

Address correspondence and reprint requests to Dr Kim, Department of Neurology, Asan Medical Center, Song Pa PO Box 145, Seoul 138-600, Korea; e-mail: jongskim{at}amc.seoul.kr

Objective: To characterize sensory symptoms in patients with stroke occurring in the cerebral cortex.

Methods: We studied clinical and imaging findings of 24 patients who had prominent sensory symptoms without definitive motor dysfunction.

Results: According to the sensory manifestations, patients were divided into dominant impairment of primitive sensation (DIPS) group, dominant impairment of cortical sensation (DICS) group, and paresthesia-only group. DIPS was related to lesions involving the parietal operculum and the insular cortex, whereas DICS was related to the lesions affecting the postcentral gyrus. Patients with paresthesia only had smaller lesions located in the postcentral gyrus. DIPS group patients were more often women (p = 0.013), more often had dysarthria (n = 0.043), and more often developed central poststroke pain or paresthesia (n = 0.005) than the DICS group patients. Restricted sensory changes are common, predominantly involving the perioral or finger areas.

Conclusions: Sensory patterns in these patients are generally consistent with the dichotomized (SI and SII) sensory system in the cerebral cortex. Involvement of insular and opercular areas is related to primitive sensory impairment and development of central poststroke pain, whereas postcentral gyrus involvement is related to cortical sensory loss without poststroke pain. The pattern of restricted sensory changes is generally consistent with the Penfield sensory topography.

Commentary, see page 167

Supported by a research fund from the Korean Ministry of Health and Welfare (03-PJ1-PG1-CH06-0001) and a grant from Brain Research Center of the 21st Century Frontier Research Program funded by the Ministry of Science and Technology of Korea (M103KV010010 06K2201 01010).

Disclosure: The author reports no conflicts of interest.

Received April 17, 2006. Accepted in final form October 4, 2006.

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