Universal dissociated anesthesia due to bilateral brain-stem infarcts
N. Venna and T. D. Sabin
A 59-year-old man had loss of pin-prick and temperature sensation over his
head, face, neck, trunk, and all extremities while light touch, vibration,
joint position sense, and deep pain were preserved. This was the cumulative
result of infarctions in the territories of the right superior cerebellar
and left posterior inferior cerebellar arteries that occurred three years
apart. To our knowledge, a syndrome of bilateral discrete interruption of
spinothalamic tracts and of the spinal tracts of the trigeminal system in
the brain stem has not been reported. Dissociated sensory loss enveloping
the entire body accompanied by truncal and limb ataxia without weakness
demonstrated a striking clinical picture. The preservation of deep somatic
and visceral pain when cutaneous pain sensation was lost was another
notable feature. We review the causes of widespread dissociated sensory
loss and discuss the implications of the dissociation of deep from
superficial pain.
