1. What is the localizing significance of the fact that essentially all sensory modalities are involved in this case, as opposed to the sparing of one or more of the modalities?
The lesion is above the middle third of the pons on the right side.
2. What is the meaning or significance of this patient’s difficulty with left upper limb coordination?
Probably due to joint position sense impairment
3. Indicate the possible anatomical locations of the pathologic process in this case.
Right tegmentum of the upper half of the pons or midbrain, right VPM/VPL nuclei of the thalamus, right posterior limb of the internal capsule, right postcentral gyrus
4. Indicate the specific structures possibly involved by the pathologic process.
Right medial, spinal, and trigeminal lemnisci, right VPM/VPL, right postcentral gyrus
5. This patient’s signs and symptoms constitute a classic neurologic syndrome. What is the name of that syndrome, and what is its usual cause?
Pure hemisensory stroke. Lacunar infarct, involving the VPM/VPL nuclei of the thalamus
6. In general, what type of pathologic process do you think is involved in this case?
Vascular – Central (penetrating) branches of the posterior cerebral artery (posterolateral group)
7. What diagnostic procedure(s) would you undertake at this point?
References:
1. Fisher CM. Neurology 1965;15:76-80.
2. Fisher CM. Neurology 1982;32:871-876.
3. Jickling GC, Stamova B, Ander BP, et al. Ann Neurol 2011;70:477-485.
4. Bezerra DC, Sharrett AR, Matsushita K, et al. Neurology 2012;78:102-108.
Click here for images
