title: Crossed cheiro-oral syndrome.
abstract: OBJECTIVE
  Cheiro-oral syndrome is characterized by sensory impairment confined to perioral area and ipsilateral fingers/hand. It results from an involvement of the ascending sensory tracts above the pons. However, a crossed pattern of perioral and acral paresthesia was rarely reported before.
  
  
  METHODS
  This study reports the neuroanatomic relationship, course and clinical significance of perioral and contralateral acral paresthesia in four patients. We term it the crossed cheiro-oral syndrome.
  
  
  RESULTS
  All patients had lateral or dorsolateral medullary infarctions that were ipsilateral to their perioral paresthesia. The contributory origin is considered a diagonal lesion involving the par oralis fibers within the descending trigeminal sensory tract and acral portion of the lateral spinothalamic tract at the lateral portion of medulla oblongata. Despite of a restricted sensory disturbance at initial, progressive neurological disability terminated to Wallenberg's syndrome ensued in three patients and disabling deficits persisted in two of them.
  
  
  CONCLUSIONS
  The crossed cheiro-oral syndrome seems a mild form of Wallenberg's syndrome. Therefore, it predicts medullary involvement and is also a warning sign for progression.
authors.affiliation: Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, and School of Medicine, Chang Gung University, 123 Tai Pei Road, Niao Sung Hsiang, Kaohsiung County 833, Taiwan. e49130@ms14.hinet.net
authors.forename: Wei-Hsi
authors.initials: WH
authors.lastname: Chen
authors.forename: Tzu-Hui
authors.initials: TH
authors.lastname: Li
authors.forename: Tsung-Hwa
authors.initials: TH
authors.lastname: Chen
authors.forename: Hung-Sheng
authors.initials: HS
authors.lastname: Lin
authors.forename: Ming-Ching
authors.initials: MC
authors.lastname: Hsu
authors.forename: Shun-Sheng
authors.initials: SS
authors.lastname: Chen
authors.forename: Jia-Shou
authors.initials: JS
authors.lastname: Liu
mesh_terms: D000328:Adult; D002561:Cerebrovascular Disorders / Q000150:complications / Q000473:pathology*; D005260:Female; D006801:Humans; D014854:Lateral Medullary Syndrome / Q000150:complications / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000473:pathology*; D010292:Paresthesia / Q000150:complications / Q000473:pathology*; D013577:Syndrome