Spinal cheiro-oral syndrome: a common neurological entity in an unusual site.
OBJECTIVE
Cheiro-oral syndrome (COS) is an established neurological entity characterized by a sensory impairment confined to the mouth angle and ipsilateral finger(s)/ hand. The current understanding of localization is a concomitant involvement of the spinothalamic and trigeminothalamic tract between the cortex and pons. The cervical spinal cord has not been mentioned in this situation yet, and this unusual location may heretofore increase the risk of misdiagnosis.


METHODS
Six patients who presented with unilateral COS due to cervical cord disorder are reported.


RESULTS
All patients were women and their age ranged between 42 and 70 years. Their neurological deficits included unilateral paraesthesiae restricted to cheirooral distribution, positive radicular sign, and mild change of tendon reflex. Cervical spinal stenosis at middle/lower cervical spine with variable magnitude of cord compression and intrinsic cord damage was found. A diagnostic dilemma obviously arises from the lack of tangible neurological signs or typical pattern of myelopathy, in addition to the previous concept of cerebral involvement. A benign course ensued in all reported patients.


CONCLUSIONS
Cheiro-oral syndrome can be an early neurological sign for cervical cord disorder; it further suggests that it is a strong neurological but weak localizing sign. A reciprocal influence of multiple factors is considered to generate COS at the cervical cord. Therefore, an absence of brain pathology should lead to a thorough examination of the cervical cord in case of COS.
Department of Neurology, Chang Gung Memorial Hospital - Kaohsiung Medical Center and College of Medicine, Chang Gung University, Kaohsiung, Taiwan.
Hung-Sheng
HS
Lin
Department of Pathology, Kaohsiung Medical University Hospital and College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Hsin-Ling
HL
Yin
Department of Neurosurgery, Paochien Hospital, Pingtung, Taiwan; Graduate Institute of Science and Technology Law, National Kaohsiung First University of Science and Technology, Kaohsiung, Taiwan.
Chi-Chui
Department of Neuroradiology, Chang Gung Memorial Hospital - Kaohsiung Medical Center and College of Medicine, Chang Gung University, Kaohsiung, Taiwan.
Chun-Chung
CC
Lui
Department of Neurology, Chang Gung Memorial Hospital - Kaohsiung Medical Center and College of Medicine, Chang Gung University, Kaohsiung, Taiwan; Graduate Institute of Science and Technology Law, National Kaohsiung First University of Science and Technology, Kaohsiung, Taiwan; Department of Neurology, Kaohsiung Medical University Hospital and College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: brainhemostasis@yahoo.com.
Wei-Hsi
WH
Chen
D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000473:pathology; D005260:Female; D005385:Fingers / Q000002:abnormalities*; D006801:Humans; D008875:Middle Aged; D009056:Mouth Abnormalities / Q000175:diagnosis*; D011044:Poland; D012720:Severity of Illness Index; D013118:Spinal Cord Diseases / Q000175:diagnosis* / Q000473:pathology; D013130:Spinal Stenosis / Q000175:diagnosis*; D013577:Syndrome