Teaching NeuroImage: Sensory level in parietal lobe lesion
Young-Mok Song, MD,
Jae Il Kim, MD,
Geun Ho Lee, MD and
Chang-Min Lee, MD
From the Department of Neurology, Dankook University Hospital, Cheonan, South Korea.
Address correspondence and reprint requests to Dr. Young-Mok Song, Department of Neurology, Dankook University Hospital, 16-5, Anseo-Dong, Cheonan, Chungnam, 330-715, South Korea ymsong{at}medimail.co.kr
A 59-year-old man presented with a sensory level on the righttrunk. He noted hypesthesia and tingling sensation on his rightthigh and gluteal areas 5 days previously. Neurologic examinationrevealed that all primary sensory modalities including touch,pain, temperature, vibration, and position senses were markedlydiminished below T10 on the right side. Mild weakness of theright proximal leg was also observed. During hospitalization,his sensory deficits extended to the upper body areas up tothe face (figure 1), which was followed by progressive leg,arm, and facial paresis on the right side. Brain MRI performedwhen hemisensory loss occurred showed a mass lesion mainly involvingthe postcentral gyrus of the parietal lobe (figure 2). The lesionwas proven to be a brain abscess caused by Klebsiella pneumoniaein the culture study from the burr-hole drainage specimen. Althoughthe finding of a sensory level usually indicates a spinal cordor lower brainstem lesion,1 it can result from a lesion in theparietal lobe.2 The sensory level at the thoracic dermatomemight be attributable to the parietal lesion involving the sensoryareas for the leg and the lower part of the trunk sparing theremaining upper part of the trunk. As the lesion expanded toadjacent receptive areas for the upper trunk, arm, and face,the sensory level ascended gradually, and all hemibody was finallyinvolved.
Figure 1 Features of the progressive sensory deficits
The patient developed hypesthesia and paresthesia along the L2–L3 dermatome followed by a sensory level to pain, temperature, vibration, and position sensation on the right trunk. The sensory level progressively ascended to the upper level of dermatome, finally leading to hemisensory loss. HD = hospitalization day.
(A) Brain T1-weighted MRI with gadolinium enhancement shows a round shaped mass lesion with rim enhancement and perilesional edema mainly involving the postcentral gyrus of the left parietal lobe (the arrow indicates the central sulcus). (B) At the coronal view, the lesion is located in the upper medial portion of the left parietal lobe.
Disclosure: The authors report no conflicts of interest.
Received November 21, 2006. Accepted in final form February5, 2007.
Matsumoto S, Okuda B, Imai T, Kameyama M. A sensory level on the trunk in lower lateral brainstem lesions. Neurology 1988;38:1515–1519.[Abstract/Free Full Text]
Breuer AC, Cuervo H, Selkoe DJ. Hyperpathia and sensory level due to parietal lobe arteriovenous malformation. Arch Neurol 1981;38:722–724.[Abstract/Free Full Text]
Top.
REFERENCES
