“Salt and Pepper” in the Eye and Face: A Prelude to Brainstem Ischemia

Conforto, Adriana Bastos; Martin, Maria da Graça Morais; Ciríaco, Jovana Gobbi Marchesi; Leite, Cláudia C.; Campos, Cynthia Resende; Yamamoto, Fábio Iuji; Puglia, Paulo; Gattás, Gabriel; Scaff, Milberto

doi:10.1016/j.ajo.2007.03.030

Cited by 7 publications

(7 citation statements)

References 4 publications

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“…In several of these cases, the painful sensation heralded the subsequent development of neurological symptoms. The MRI showed paramedian pontine infarcts 17,18 and in one case series, 17 focal neurological symptoms and deficits such as numbness and ataxic hemiparesis. In these cases, MRI also showed paramedian pontine infarctions.…”

Section: Consider Stroke In the Ponsmentioning

confidence: 83%

“…In these patients, the pain was located in the distal arm 9 and dorsum of the foot, 10 respectively. One patient had left‐sided hemiballismus‐hemichorea, left inferior quadrantanopia, left‐sided sensory deficits/tactile hemi‐extinction, and slight ataxic hemiparesis 17 . The other patient had an accompanying left leg weakness and diminished pinprick, light touch, temperature, and vibratory sensation 10 .…”

Section: Resultsmentioning

confidence: 99%

“…One patient had left-sided hemiballismus-hemichorea, left inferior quadrantanopia, left-sided sensory deficits/tactile hemiextinction, and slight ataxic hemiparesis. 17 The other patient had an accompanying left leg weakness and diminished pinprick, light touch, temperature, and vibratory sensation. 10 In the aforementioned patient, the painful sensation remitted after 48 h. 9 MRI revealed an ischemic lesion in the anterior parietal cortex 9 and right parasagittal parietal cortex, 10 respectively.…”

Section: Re Sultsmentioning

confidence: 98%

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Atypical painful stroke presentations: A review

Bayat

Blauenfeldt

2022

Acta Neuro Scandinavica

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Stroke is a leading cause of death and disability. Reperfusion therapies with intravenous thrombolysis and mechanical thrombectomy have greatly improved outcomes but the therapeutic time window remains narrow. 1 Prehospital delay and presentation outside this time window is the leading cause of not receiving reperfusion therapy 2 Causes of prehospital delay are multifactorial but impaired stroke symptom awareness and help seeking behavior in patients and missed identification of stroke by healthcare professionals may play an important role. 3,4 Some patients may present with atypical symptoms leading to an initial misdiagnosis, increased prehospital delay, and missed treatment with thrombolysis or thrombectomy.Stroke "chameleons" are patients with actual stroke who have atypical or unusual presentations, mimicking a non-vascular cause. 5 Presenting as a "stroke chameleon" may be associated with a worse outcome. 6 One of the very rare presentations of stroke is initial neurogenic pain. Post-stroke pain is well-known amongst neurologists but pain as an initial symptom of stroke is not a well-known entity.It has been anecdotally described but a review of painful stroke presentations has not been published previously. Acute trigeminal neuralgia, atypical facial pain, hemisensory pain, and episodic pain

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Section: Consider Stroke In the Ponsmentioning

confidence: 83%

Section: Resultsmentioning

confidence: 99%

Section: Re Sultsmentioning

confidence: 98%

See 1 more Smart Citation

Atypical painful stroke presentations: A review

Bayat

Blauenfeldt

2022

Acta Neuro Scandinavica

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“…Previous investigations have described this sensation as sharp, burning or ‘salt and pepper’ in or around the eyes. Researchers suggest involvement of the quintothalamic tract in the pons as the primary cause 4–6…”

Section: Discussionmentioning

confidence: 99%

“…Brainstem pure or predominant sensory strokes are usually caused by a paramedian dorsal pontine lesion involving the medial lemniscus tract and can present with mild transient non-sensory symptoms, most commonly dizziness and gait ataxia 3. Acute ocular pain has also been implicated in impending brainstem ischaemia 4–6. This case report highlights a pure sensory brainstem stroke with subtle clinical features that help to localise its origin within the brain.…”

Section: Introductionmentioning

confidence: 97%

Pure sensory stroke due to brainstem lesion

McCreery

Fekete

2019

BMJ Case Rep

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A 40-year-old male patient presented to the emergency department with acute onset right-sided upper and lower extremity numbness/tingling over the past day. Prior to the paraesthesia onset, the patient experienced transient mild ataxia and left ocular pain with complete resolution at the time of presentation. Neurological exam revealed isolated right-sided sensory changes from his hand-to-elbow as well as foot-to-knee. No other focal neurological deficits were noted. MRI brain revealed a small left posterior infarct at the junction between the pons and midbrain. Dual-antiplatelet therapy was initiated and the patient experienced minimal paraesthesia improvement proximally over his 5-day hospital course. This case report highlights an acute brainstem stroke presenting with predominant hemisensory symptoms. Presentations of brainstem lesions can range from subtle, non-specific features to profound deficits. This case serves to emphasise the importance of performing a thorough clinical exam while maintaining a high index of suspicion for brainstem lesions.

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