Opercular cheiro-oral syndrome
J. Bogousslavsky, K. Dizerens, F. Regli and P. A. Despland
Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Perioral and distal upper limb sensory dysfunction (cheiro-oral syndrome)
has classically been attributed to cortical involvement. In previously
reported cases of the syndrome, caused by stroke, however, the thalamus or
brain stem has been the actual site of the lesion. We have studied two
patients with infarct in the superficial middle cerebral artery territory
involving the parietal operculum. Sensory involvement was purely subjective
in the face, but severe hypoesthesia was present in the distal upper limb,
involving mainly position sense, stereognosis, and graphesthesia.
Temperature and pain sensation were involved in one patient. These findings
correlated with involvement of the lower part of the postcentral gyrus,
more caudal parts of the parietal operculum, and underlying white matter.
This opercular cheiro-oral syndrome seems more uncommon than
faciobrachiocrural hemihypesthesia associated with anterior parietal artery
territory infarct. A double supply to the parietal opercular region through
branches of the temporal arteries and anterior parietal artery may explain
the rarity of cheiro-oral syndrome resulting from hemisphere stroke,
because simultaneous and partial compromise to two different pial artery
networks is uncommon.
