1993 Volume 15 Issue 5 Pages 386-391
A 56-year-old hypertensive man suddenly developed dysesthesia and paresthesia of the left hand and bilateral perioral region. He also had a past history of bilateral perioral dysesthesia which lasted for a week, 10 years previously. A brain CT scan taken 3 days after the present attack demonstrated a focal high density area in the paramedian region of the right pontine tegmentum. MRI at 18 days after the onset disclosed a small high intensity area in the same region on the T1 weighted image, as well as a small high intensity spot with a low intensity rim on the T2 weighted image. The sensory disturbance of the left hand and bilateral perioral region was thought to be caused by the small pontine hemorrhage. The mechanism of this bilateral cheiro-oral syndrome was hypothesized to be as follows. A hematoma impaired the fibers which crossed the pontine tegmentum from the ipsilateral main sensory nucleus of the trigeminus to the contralateral ventral trigeminothalamic tract, in addition to disturbance of the ipsilateral medial lemniscus and the ventral trigeminothalamic tract. Furthermore, the T2 weighted image of MRI was considered to have revealed another small lesion derived from an old hemorrhage close to the new hematoma which appeared to be responsible for the bilateral perioral dysesthesia.
