[A mechanism of cheiro-oral syndrome due to brainstem lesions, a case of a dissecting aneurysm of the basilar artery].
A 42-year-old woman developed an abrupt onset of severe headache, nausea, vomiting, unstable gait and numbness around the right side of her mouth and in her right hand. Neurological examination revealed bilateral pyramidal tract signs and hypesthesia of her right palmar tip and the right side of her mouth. However, pain and temperature sensibility was preserved. Cerebrospinal fluid was clear and colorless. CT scan showed an enhancing mass in the prepontine cistern compressing the pontine base. Vertebral angiography revealed irregular narrowing of bilateral vertebral arteries (string sign) proximal to a fusiform aneurysm on the entire length of the basilar artery. MRI showed double lumina in the wall of the aneurysm. The medial lemniscus conducts the discriminatory tactile and the deep sensory impulses from the extremities. The ventral ascending tract of the trigeminal nerve conducts the discriminatory tactile sensory impulses from the face. These two tracts lie close together in the pontine tegmentum, which is also a watershed area of the paramedian branches and circumferential branches of the basilar artery. We suggest that in this case the dissecting aneurysm caused ischemia of these two tracts in the left pontine tegmentum, presenting right cheiro-oral syndrome.
Department of Neurology, Misasa-onsen National Hospital.
H
H
Nakayasu
S
S
Sue
K
K
Takahashi
T
T
Hori
Y
Y
Hokama
D000328:Adult; D000784:Aortic Dissection / Q000150:complications* / Q000175:diagnosis; D001488:Basilar Artery; D001933:Brain Stem / Q000098:blood supply*; D002544:Cerebral Infarction / Q000150:complications; D005260:Female; D006225:Hand / Q000294:innervation*; D006801:Humans; D006987:Hypesthesia / Q000209:etiology; D008279:Magnetic Resonance Imaging; D009055:Mouth / Q000294:innervation*; D009422:Nervous System Diseases / Q000209:etiology; D012677:Sensation; D013577:Syndrome; D014057:Tomography, X-Ray Computed