title: A case of superficial hemisensory dysfunction due to operculo-insular infarction: radiological depiction of thalamocortical projections to the secondary somatosensory cortex.
abstract: A 64-year-old obese man developed hypesthesia in the left arm and leg. Neurological examination revealed decreased senses of pain, touch, and temperature in the left face, arm, trunk, and leg. Remaining functions were normal. Electrocardiogram showed atrial fibrillation. Somatosensory-evoked potentials using the stimulation in the median nerve were normal on both sides. Brain magnetic resonance imaging revealed acute infarction in the right parietal operculum and insula. There were no pathognomonic lesions in the postcentral gyrus, the thalamus, or the brain stem. Cardioembolic operculo-insular infarction was diagnosed. Diffusion tensor tractography map displayed the thalamocortical projections to the primary and the secondary somatosensory cortex (S2). These radiological findings supported that the operculo-insular lesion could disrupt the thalamo-S2 pathway. Thus, the thalamocortical disconnection between the thalamus to the S2 could cause superficial hemisensory dysfunction in the present patient.
authors.affiliation: Department of Neurology, Toho University Omori Medical Center, Tokyo, Japan.
authors.forename: Takehisa
authors.initials: T
authors.lastname: Hirayama
authors.affiliation: Department of Neurology, Toho University Omori Medical Center, Tokyo, Japan. Electronic address: keni@med.toho-u.ac.jp.
authors.forename: Ken
authors.initials: K
authors.lastname: Ikeda
authors.affiliation: Department of Neurology, Toho University Omori Medical Center, Tokyo, Japan.
authors.forename: Kiyokazu
authors.initials: K
authors.lastname: Kawabe
authors.affiliation: Department of Neurology, Toho University Omori Medical Center, Tokyo, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Ishikawa
authors.affiliation: Department of Neurology, Toho University Omori Medical Center, Tokyo, Japan.
authors.forename: Konosuke
authors.initials: K
authors.lastname: Iwamoto
authors.affiliation: Department of Radiology, Toho University Omori Medical Center, Tokyo, Japan.
authors.forename: Hisanobu
authors.initials: H
authors.lastname: Harada
authors.affiliation: Department of Radiology, Toho University Omori Medical Center, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Suzuki
authors.affiliation: Department of Neurology, Toho University Omori Medical Center, Tokyo, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Iwasaki
mesh_terms: D002540:Cerebral Cortex / Q000473:pathology*; D002544:Cerebral Infarction / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology*; D056324:Diffusion Tensor Imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D009434:Neural Pathways / Q000473:pathology; D009460:Neurologic Examination; D009765:Obesity / Q000150:complications; D011859:Radiography; D012678:Sensation Disorders / Q000209:etiology* / Q000473:pathology*; D013003:Somatosensory Cortex / Q000473:pathology*; D013788:Thalamus / Q000473:pathology*