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• Vol.47 No.4
• CLINICA NEUROL, 47: 151−155, 2007
• Vol.47 No.4 contents

Case Report

A case of combined sensation disturbance and clumsiness of the left hand caused by an infarction localized to Brodmann areas 1 and 2

Yumiko Kutoku, M.D., Hiroki Hagiwara, M.D., Yaeko Ichikawa, M.D.¹⁾, Katsuhiko Takeda, M.D.²⁾ and Yoshihide Sunada, M.D.

Department of Neurology, Kawasaki Medical School
¹⁾Department of Neurology, Tokyo University
²⁾Department of Neurology, Mita Hospital International University of Health and Welfare

A 70-year-old woman was admitted to our hospital with a complaint of numbness and clumsiness of the left hand. On physical examination 23 days after the onset of cerebral infarction, she showed no apparent muscle weakness. Although her elementary somatosensory function was mostly intact with a minimal joint position sensation disturbance, she showed disturbances in tactile recognition, two-point discrimination, and weight perception. She also had difficulty in discrete finger movement of her left hand, especially when her eyes were closed. Brain MRI disclosed a small infarction localized to Brodmann areas 1 and 2 in the right postcentral gyrus. In the left median nerve short-latency somatosensory evoked potentials (s-SEPs), the N20 potential was normally evoked. This finding also indicated that the area 3b was preserved. The sensory symptoms observed in this patient were compatible with the hierarchical somatosensory processing model in the postcentral gyrus proposed by Iwamura et al, in which the elementary sensation recognized in area 3 is transferred to areas 1 and 2, and then processed to discriminative sensation. The disturbed discrete finger movement in this patient probably resulted from impaired tactile recognition which could be compensated for by visual information.

(CLINICA NEUROL, 47: 151−155, 2007)
key words: cerebral infarction, postcentral gyrus, somatosensation, combined sensation, SEP

(Received: 16-Mar-06)