title: Crossed cheiro-oral syndrome: A warning sign for medullary involvement and neurological deterioration.
abstract: Crossed cheiro-oral syndrome (CCOS) is characterized by crossed sensory disturbance confined to the unilateral perioral area and contralateral hand/finger(s). Although a few classical crossed sensory syndromes accurately predict brainstem or spinal involvement, the clinical significance of CCOS remains unclear. In this study, we analyzed the etiology, localization and outcome of CCOS patients. The results showed that ischemic stroke is the exclusive cause of CCOS. The location of responsible stroke is pertinent to the middle or upper level of the lateral medulla oblongata medial to the lateral sulcus. The vascular supply is from the vertebral artery or the posterior inferior cerebellar artery. Half of the CCOS patients progressed to Wallenberg's syndrome and complicated with disabled daily living. However, no patient died during the follow-up period. A larger size and dorsal extension of the infarction correlated with neurological deterioration. Therefore, CCOS is an independent clinical sign of medullary involvement. It strongly predicts involvement at the lateral medulla oblongata, especially the ischemic stroke, and neurological deterioration. A rapid evaluation of the infarction location and vascular status is suggested in cases of CCOS.
authors.affiliation: Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Kaohsiung City, Taiwan.
authors.forename: Wei-Hsi
authors.initials: WH
authors.lastname: Chen
authors.affiliation: Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Kaohsiung City, Taiwan.
authors.forename: Tsung-Pei
authors.initials: TP
authors.lastname: Yang
authors.affiliation: Department of Clinical Forensic Medicine, Kaohsiung Medical University Hospital and College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan. Electronic address: schoolyin@cc.kmu.edu.tw.
authors.forename: Hsin-Ling
authors.initials: HL
authors.lastname: Yin
mesh_terms: D000328:Adult; D000368:Aged; D020526:Brain Stem Infarctions / Q000150:complications / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D014854:Lateral Medullary Syndrome / Q000503:physiopathology*; D008297:Male; D008526:Medulla Oblongata / Q000473:pathology*; D008875:Middle Aged; D020886:Somatosensory Disorders / Q000209:etiology / Q000503:physiopathology*
keywords: Cheiro-oral; Disability; Medulla oblongata; Stroke; Wallenberg’s syndrome