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Clinical Features and Anatomic Correlates

Jeremy D. Schmahmann, MD; Dana Leifer, MD

Arch Neurol. 1992;49(10):1032-1037.

Abstract
• We studied six patients who developed spontaneous hemibody pain following lesions of the parietal lobe. The pain was characterized as burning or icelike, and was associated with impairment of pin and temperature appreciation. Computed tomographic scanning showed that the common area of involvement in all cases was the white matter deep to both the caudal insula and the opercular region of the posterior parietal cortex. We suggest that disruption of the interconnections between these cerebral cortical areas (including the second somatosensory representation, SII) and the thalamus, particularly the intralaminar and ventroposterior nuclei, may be responsible for producing a thalamocortical disconnection syndrome with spontaneous pain as its clinical manifestation.

Author Affiliations
From the Departments of Neurology, Massachusetts General Hospital and Harvard Medical School (Drs Schmahmann and Leifer), and Children's Hospital (Dr Leifer), Boston, Mass, and the Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Mass (Dr Schmahmann).

Footnotes
Accepted for publication June 25, 1992.

Presented in part at the 41st Annual Meeting of the American Academy of Neurology, Chicago, III, April 17, 1989.

Reprint requests to the Department of Neurology, Kennedy 905B, Massachusetts General Hospital, 14 Fruit St, Boston, MA 02114 (Dr Schmahmann).

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