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Hanada K, Yokoi K, Kashida N, Shimomura R, Murata D, Hirayama K. Midlateral medullary infarction presenting with isolated thermoanaesthesia: a case report. BMC Neurol 2022; 22:268. [PMID: 35854223 PMCID: PMC9295273 DOI: 10.1186/s12883-022-02796-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 07/13/2022] [Indexed: 11/21/2022] Open
Abstract
Background A small lateral medullary lesion could produce isolated impairment of temperature sensation without concomitant impaired pain sensation. However, only one such case has ever been reported, and there are no reports on subjective symptoms and detailed somatosensory testing. Case presentation Herein, we report the case of a 53-year-old female patient presenting with impaired temperature sensation on the left half of her body, from the neck down, following a small infarction of the right midlateral medulla. The chronological changes in the patient's introspection regarding impairment of thermoception and the results of detailed somatosensory tests, including thermal sense, are shown in this report. Conclusions Thorough somatosensory tests, personal descriptions of symptoms, and electrophysiological quantification of similar cases are needed to improve our understanding of the neurological separation of the sensations of pain and temperature at the medullary level.
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Affiliation(s)
- Keisuke Hanada
- Department of Rehabilitation, Suishokai Murata Hospital, Osaka City, Japan. .,Department of Rehabilitation, Kinsyukai Hanwa Memorial Hospital, 3-5-8, Minami-sumiyoshi, Sumiyoshi ward, Osaka, 558-0011, Japan. .,Department of Occupational Therapy, Graduate School of Rehabilitation Science, Osaka Metropolitan University, Habikino City, Osaka, Japan.
| | - Kayoko Yokoi
- Department of Occupational Therapy, Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata City, Japan
| | - Natsuko Kashida
- Department of Rehabilitation, Suishokai Murata Hospital, Osaka City, Japan
| | - Ryota Shimomura
- Department of Rehabilitation, Suishokai Murata Hospital, Osaka City, Japan
| | - Daiki Murata
- Department of Neurosurgery, Suishokai Murata Hospital, Osaka City, Japan
| | - Kazumi Hirayama
- Department of Occupational Therapy, Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata City, Japan
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Scheuren PS, David G, Kramer JLK, Jutzeler CR, Hupp M, Freund P, Curt A, Hubli M, Rosner J. Combined Neurophysiologic and Neuroimaging Approach to Reveal the Structure-Function Paradox in Cervical Myelopathy. Neurology 2021; 97:e1512-e1522. [PMID: 34380751 DOI: 10.1212/wnl.0000000000012643] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/16/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To explore the so-called structure-function paradox in individuals with focal spinal lesions by means of tract-specific MRI coupled with multimodal evoked potentials and quantitative sensory testing. METHODS Individuals with signs and symptoms attributable to cervical myelopathy (i.e., no evidence of competing neurologic diagnoses) were recruited at the Balgrist University Hospital, Zurich, Switzerland, between February 2018 and March 2019. We evaluated the relationship between the extent of structural damage within spinal nociceptive pathways (i.e., dorsal horn, spinothalamic tract, anterior commissure) assessed with atlas-based MRI and (1) the functional integrity of spinal nociceptive pathways measured with contact heat-, cold-, and pinprick-evoked potentials and (2) clinical somatosensory phenotypes assessed with quantitative sensory testing. RESULTS Sixteen individuals (mean age 61 years) with either degenerative (n = 13) or posttraumatic (n = 3) cervical myelopathy participated in the study. Most individuals presented with mild myelopathy (modified Japanese Orthopaedic Association score >15; n = 13). A total of 71% of individuals presented with structural damage within spinal nociceptive pathways on MRI. However, 50% of these individuals presented with complete functional sparing (i.e., normal contact heat-, cold-, and pinprick-evoked potentials). The extent of structural damage within spinal nociceptive pathways was not associated with functional integrity of thermal (heat: p = 0.57; cold: p = 0.49) and mechano-nociceptive pathways (p = 0.83) or with the clinical somatosensory phenotype (heat: p = 0.16; cold: p = 0.37; mechanical: p = 0.73). The amount of structural damage to the spinothalamic tract did not correlate with spinothalamic conduction velocity (p > 0.05; ρ = -0.11). DISCUSSION Our findings provide neurophysiologic evidence to substantiate that structural damage in the spinal cord does not equate to functional somatosensory deficits. This study recognizes the pronounced structure-function paradox in cervical myelopathies and underlines the inevitable need for a multimodal phenotyping approach to reveal the eloquence of lesions within somatosensory pathways.
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Affiliation(s)
- Paulina Simonne Scheuren
- From the Spinal Cord Injury Center (P.S.S., G.D., M. Hupp, P.F., A.C., M. Hubli, J.R.), Balgrist University Hospital, University of Zurich, Switzerland; International Collaboration on Repair Discoveries (ICORD) (J.L.K.K.), Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine (J.L.K.K.), University of British Columbia, Vancouver, Canada; Department of Biosystems Science and Technology (C.R.J.), Swiss Federal Institute of Technology Zurich, Switzerland; Wellcome Centre for Human Neuroimaging (P.F.), UCL Institute of Neurology, UCL, London, UK; Department of Neurophysics (P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; and Department of Neurology (J.R.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Gergely David
- From the Spinal Cord Injury Center (P.S.S., G.D., M. Hupp, P.F., A.C., M. Hubli, J.R.), Balgrist University Hospital, University of Zurich, Switzerland; International Collaboration on Repair Discoveries (ICORD) (J.L.K.K.), Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine (J.L.K.K.), University of British Columbia, Vancouver, Canada; Department of Biosystems Science and Technology (C.R.J.), Swiss Federal Institute of Technology Zurich, Switzerland; Wellcome Centre for Human Neuroimaging (P.F.), UCL Institute of Neurology, UCL, London, UK; Department of Neurophysics (P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; and Department of Neurology (J.R.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - John Lawrence Kipling Kramer
- From the Spinal Cord Injury Center (P.S.S., G.D., M. Hupp, P.F., A.C., M. Hubli, J.R.), Balgrist University Hospital, University of Zurich, Switzerland; International Collaboration on Repair Discoveries (ICORD) (J.L.K.K.), Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine (J.L.K.K.), University of British Columbia, Vancouver, Canada; Department of Biosystems Science and Technology (C.R.J.), Swiss Federal Institute of Technology Zurich, Switzerland; Wellcome Centre for Human Neuroimaging (P.F.), UCL Institute of Neurology, UCL, London, UK; Department of Neurophysics (P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; and Department of Neurology (J.R.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Catherine Ruth Jutzeler
- From the Spinal Cord Injury Center (P.S.S., G.D., M. Hupp, P.F., A.C., M. Hubli, J.R.), Balgrist University Hospital, University of Zurich, Switzerland; International Collaboration on Repair Discoveries (ICORD) (J.L.K.K.), Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine (J.L.K.K.), University of British Columbia, Vancouver, Canada; Department of Biosystems Science and Technology (C.R.J.), Swiss Federal Institute of Technology Zurich, Switzerland; Wellcome Centre for Human Neuroimaging (P.F.), UCL Institute of Neurology, UCL, London, UK; Department of Neurophysics (P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; and Department of Neurology (J.R.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Markus Hupp
- From the Spinal Cord Injury Center (P.S.S., G.D., M. Hupp, P.F., A.C., M. Hubli, J.R.), Balgrist University Hospital, University of Zurich, Switzerland; International Collaboration on Repair Discoveries (ICORD) (J.L.K.K.), Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine (J.L.K.K.), University of British Columbia, Vancouver, Canada; Department of Biosystems Science and Technology (C.R.J.), Swiss Federal Institute of Technology Zurich, Switzerland; Wellcome Centre for Human Neuroimaging (P.F.), UCL Institute of Neurology, UCL, London, UK; Department of Neurophysics (P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; and Department of Neurology (J.R.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Patrick Freund
- From the Spinal Cord Injury Center (P.S.S., G.D., M. Hupp, P.F., A.C., M. Hubli, J.R.), Balgrist University Hospital, University of Zurich, Switzerland; International Collaboration on Repair Discoveries (ICORD) (J.L.K.K.), Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine (J.L.K.K.), University of British Columbia, Vancouver, Canada; Department of Biosystems Science and Technology (C.R.J.), Swiss Federal Institute of Technology Zurich, Switzerland; Wellcome Centre for Human Neuroimaging (P.F.), UCL Institute of Neurology, UCL, London, UK; Department of Neurophysics (P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; and Department of Neurology (J.R.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Armin Curt
- From the Spinal Cord Injury Center (P.S.S., G.D., M. Hupp, P.F., A.C., M. Hubli, J.R.), Balgrist University Hospital, University of Zurich, Switzerland; International Collaboration on Repair Discoveries (ICORD) (J.L.K.K.), Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine (J.L.K.K.), University of British Columbia, Vancouver, Canada; Department of Biosystems Science and Technology (C.R.J.), Swiss Federal Institute of Technology Zurich, Switzerland; Wellcome Centre for Human Neuroimaging (P.F.), UCL Institute of Neurology, UCL, London, UK; Department of Neurophysics (P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; and Department of Neurology (J.R.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Michèle Hubli
- From the Spinal Cord Injury Center (P.S.S., G.D., M. Hupp, P.F., A.C., M. Hubli, J.R.), Balgrist University Hospital, University of Zurich, Switzerland; International Collaboration on Repair Discoveries (ICORD) (J.L.K.K.), Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine (J.L.K.K.), University of British Columbia, Vancouver, Canada; Department of Biosystems Science and Technology (C.R.J.), Swiss Federal Institute of Technology Zurich, Switzerland; Wellcome Centre for Human Neuroimaging (P.F.), UCL Institute of Neurology, UCL, London, UK; Department of Neurophysics (P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; and Department of Neurology (J.R.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Jan Rosner
- From the Spinal Cord Injury Center (P.S.S., G.D., M. Hupp, P.F., A.C., M. Hubli, J.R.), Balgrist University Hospital, University of Zurich, Switzerland; International Collaboration on Repair Discoveries (ICORD) (J.L.K.K.), Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine (J.L.K.K.), University of British Columbia, Vancouver, Canada; Department of Biosystems Science and Technology (C.R.J.), Swiss Federal Institute of Technology Zurich, Switzerland; Wellcome Centre for Human Neuroimaging (P.F.), UCL Institute of Neurology, UCL, London, UK; Department of Neurophysics (P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; and Department of Neurology (J.R.), University Hospital Bern, Inselspital, University of Bern, Switzerland.
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