Cases reported "Somatosensory Disorders"

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1/12. Pseudodystonic hand posturing contralateral to a metastasis of the parietal association cortex.

    A 56 year-old patient, with a history of surgically removed breast cancer three years earlier, presented with incoordination of hand movements while playing piano. Neurological examination disclosed mild position sensory loss and limb-kinetic apraxia of the distal part of the right upper extremity. The most conspicuous neurological sign was a dystonic posturing of the right hand, which was only elicited when the patient outstretched her arms with the eyes closed. MRI revealed a metastatic lesion involving the left parietal cortex. The association of focal dystonic postures with lesions of the parietal association cortex indicates that dystonia may feature damage of brain cortical areas far from the basal ganglia. In addition, this provides support to the hypothesis that impairment of sensory pathways may play a role in the origin of some hyperkinetic movement disorders, such as dystonia and athetosis.
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2/12. Somatosensory and skin temperature disturbances caused by infarction of the postcentral gyrus: a case report.

    Somatosensory functions are subdivided into 2 large groups: the elementary somatosensory functions, which consist of light touch, pain, thermal sensation, joint position sense, and vibration sense, and the intermediate somatosensory functions, which include 2-point discrimination, tactile localization, weight, texture, and shape perception. In this report, we describe a patient with somatosensory dysfunction after infarction of the postcentral gyrus. On physical examination a month after the onset of the infarction, voluntary movements were skillful, and both the elementary and intermediate somatosensory functions were disturbed in the right hand. The patient also displayed a decrease in the skin temperature of the right hand. The sensory-evoked potential in response to electrical stimulation of the right median nerve was normal, and brain MRI showed that the infarction was located in the posterior half of the left postcentral gyrus. These findings suggested that the lesion was situated at areas 1 and 2, and that area 3b was preserved. thermography revealed that the skin temperature of the right hand was decreased predominantly on the ulnar side, and that recovery from cooling with ice water was delayed. By comparing the results of our patient with a case report that showed no disturbance of the elementary somatosensory functions with a localized lesion in the postcentral gyrus, we suggest that area 1 participates in the elementary somatosensory functions and that skin temperature may be controlled somatotopically in the somatosensory cortex.
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ranking = 0.16666666666667
keywords = cortex
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3/12. motor cortex stimulation in a patient with intractable complex regional pain syndrome type II with hemibody involvement. Case report.

    The authors describe the effectiveness of motor cortex stimulation (MCS) in a patient with complex regional pain syndrome (CRPS) Type II, formerly known as causalgia, with hemibody allodynia. During MCS, a subjective sensation of warm paresthesia developed in the painful hand and forearm and spread toward the trunk. pain and allodynia in the areas associated with this sensation were alleviated significantly. The analgesic effect of stimulation proved to be long lasting and was still present at the 12-month follow up. The authors speculate that MCS might exert its effect through the modulation of thalamic activity in this particular case of CRPS with hemisensory deficit. A central mechanism associated with functional disturbance in noxious-event processing in the thalamus might have an important role in the pathogenesis of the condition.
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ranking = 0.83333333333333
keywords = cortex
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4/12. Referred sensations in patients with complex regional pain syndrome type 1.

    OBJECTIVES: This study sought to explore and characterize referred sensations (RS) in patients with complex regional pain syndrome (CRPS) type 1 and test the hypothesis that pain in CRPS is associated with central sensory changes. methods: Subjects underwent standardized neurological examination involving light touch, pinprick and vibration sense with eyes closed and then with eyes open. The subjects described the location and sensation emanating from the stimulated site and whether they experienced any sensations (similar or different) elsewhere. RESULTS: Five of 16 subjects recruited demonstrated RS. These were experienced in real time, were modality specific (touch and pinprick) and were located on the body part immediately adjacent, on Penfield's cortical homunculus, to the stimulated site. The RS were diminished or absent when the subject visualized the stimulated area. They disappeared when stimulation ceased and on clinical improvement. CONCLUSIONS: This is the first report of RS in CRPS and provides further evidence of central reorganization in what was previously thought to be a peripheral disorder.
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ranking = 0.00049919220989115
keywords = visual
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5/12. Evidence for a unimodal somatosensory attention system.

    Extinction is generally viewed as a disorder of selective attention for spatial locations. Recent physiologic, behavioral and lesion studies view spatial locations as a complex construct in which multiple modalities and motor systems are integrated. Accordingly, cross-modal and sensory-motor conditions often modify extinction. In a patient with tactile extinction, we tested the hypothesis that attentional deficits can also be confined to a specific sensory modality. Using objectively and subjectively balanced tactile stimuli and signal detection analysis, we found that our patient's contralesional tactile discrimination was not modulated by proprioceptive or visual input or by movement. By contrast, increasing the salience of the contralesional tactile stimuli did improve her contralesional tactile discrimination, consistent with our hypothesis that she suffered from a modality-specific attentional deficit. Additionally, she did not have any evidence of visual extinction, again bolstering our claim that her extinction was confined to touch. These data suggest that in addition to polymodal and sensory-motor attentional systems, spatial attention also operates on specific sensations. We also advocate the use of signal detection analysis, a method that has been surprisingly neglected in extinction research.
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ranking = 0.00099838441978229
keywords = visual
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6/12. Motor excitability in a patient with a somatosensory cortex lesion.

    OBJECTIVE: We report a patient with an ischemic lesion in right somatosensory cortex who developed dystonic posturing and pseudo-athetotic involuntary left-sided finger movements during voluntary muscle contractions. methods: Motor excitability was assessed using transcranial magnetic stimulation techniques and electrical peripheral nerve stimulation. Results obtained from abductor digiti minimi muscles of both hands were compared. RESULTS: On the affected side, silent period duration and intracortical inhibition were reduced, indicating a loss of inhibitory properties. Intracortical facilitation was enhanced. Stimulus-response curves showed a smaller increase of motor evoked potential amplitudes when recorded during muscle relaxation, but not during voluntary muscle activation. CONCLUSIONS: The results suggest that, under normal conditions, somatosensory cortex modifies inhibitory as well as excitatory properties in the motor system.
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keywords = cortex
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7/12. A cognitive neuropsychological and psychophysiological investigation of a patient who exhibited an acute exacerbated behavioural response during innocuous somatosensory stimulation and movement.

    We report findings from a cognitive neuropsychological and psychophysiological investigation of a patient who displayed an exacerbated acute emotional expression during movement, innocuous, and aversive somatosensory stimulation. The condition developed in the context of non-specific white matter ischaemia along with abnormalities in the cortical white matter of the left anterior parietal lobe, and subcortical white matter of the left Sylvian cortex. Cognitive neuropsychological assessment revealed a pronounced deficiency in executive function, relative to IQ, memory, attention, language and visual processing. Compared to a normal control group, the patient [EQ] displayed a significantly elevated skin conductance level during both innocuous and aversive somatosensory stimulation. His pain tolerance was also significantly reduced. Despite this, EQ remained able to accurately describe the form of stimulation taking place, and to rate the levels of pain intensity and pain affect. These results suggest that EQ's exaggerated behavioural response and reduced pain tolerance to somatosensory stimulation may be linked to cognitive changes, possibly related to increased apprehension and fear, rather than altered pain intensity or pain affect per se.
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ranking = 0.16716585887656
keywords = cortex, visual
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8/12. A long-lasting improvement of somatosensory function after prism adaptation, a case study.

    Previous studies have observed a reduction of visual and representational neglect symptoms after visuo-manual adaptation to rightward displacing prisms. Recently, improvements have also been observed on somatosensory tasks, such as locating the centre of a haptically explored circle and tactile double simultaneous stimulation. In the current single case study we assessed whether prism adaptation with the ipsilesional hand improved two aspects of contralesional somatosensory function, pressure sensitivity and proprioception. After the first application of prism adaptation improvements in pressure sensitivity and proprioception were observed. A second prism adaptation confirmed the improvements in contralesional somatosensory function. The effects of prism adaptation on position sense were longer lasting than have been reported previously, but consistent with reductions of visual neglect symptoms after prism adaptation. The current findings suggest that prism adaptation can have a non-spatial effect on neglect-related supra-modal deficits.
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ranking = 0.00099838441978229
keywords = visual
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9/12. Hot water epilepsy and focal malformation of the parietal cortex development.

    Hot water epilepsy (HWE) refers to a specific type of reflex epilepsy precipitated by the stimulus of bathing in hot water. HWE is considered to be a geographically specific epileptic syndrome since it mainly occurs in the Indian community. Spontaneous seizures may also occur later in life. The seizure pattern includes complex partial attacks. Although the pathogenesis of HWE is still unknown, temporal lobe has been thought to take part in the epileptogenesis. This paper reports on a 4-year-old girl who, at the age of 6 months, experienced complex partial seizures triggered by bathing in hot water. Non-provoked seizures intercritical EEG showed isolated spikes and spike-and-waves in the left parietal region. brain MRI detected a left parietal focal cortical dysplasia. This is the second patient with HWE in whom a cortical malformation has been observed. The observation present here and data reported in the literature seem to indicate that the sensory cortex might also be involved in triggering seizures precipitated by a bath in hot water. Moreover, the authors believe that MRI examination should be considered for this group of patients.
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ranking = 0.83333333333333
keywords = cortex
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10/12. Illusory persistence of touch after right parietal damage: neural correlates of tactile awareness.

    We studied a patient who experienced 'palinaesthesia', an illusion of persistent touch following tactile stimulation on the left hand, subsequent to a right parietal meningioma affecting primary somatosensory regions in the postcentral gyrus (SI) and superior parietal gyrus (Brodmann area 7), but preserving the secondary somatosensory cortex (SII) in the upper lateral sulcus. This subjective sensation was accompanied by transient increases in objective measures of tactile threshold. The patient had mild deficits in superficial tactile perception, but showed severe left-sided extinction for offsets of tactile stimuli during bilateral stimulation, but not for onsets of stimuli. Functional MRI revealed increased neural activity during palinaesthesia selectively arising within the ipsilesional-right SI cortex, but no abnormality within left SI and bilateral SII. Right SI responded to the onset of new tactile stimuli on the left hand but not to their offset. By contrast, any tactile events on either hand modulated activity in contralateral SII regions, even undetected left-sided offsets. These data demonstrate that illusory persistence of touch following stimulation on the hand may result from sustained neural activity in a restricted region of the SI cortex outlasting the offset of the actual tactile stimuli. These findings also provide direct evidence for a critical role of SI in mediating conscious somatosensory experience on contralateral parts of the body.
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