Universal Dissociated Anesthesia due to Bilateral Brain-Stem Infarcts

Venna, Nagagopal; Sabin, Thomas D.

doi:10.1001/archneur.1985.04060080104023

Cited by 2 publications

(1 citation statement)

References 16 publications

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“…8,9,[17][18][19] The severity of the spinothalamic injury in both of our patients was clearly confirmed by the lasting lack of laser-evoked potentials on the side contralateral to the lesion. 10,19 -21 The degree to which sensitivity to pain is recovered in these cases is reflected by the normalization of the laser evoked potentials.…”

Section: Discussionsupporting

confidence: 67%

Analysis of the Perception of and Reactivity to Pain and Heat in Patients With Wallenberg Syndrome and Severe Spinothalamic Tract Dysfunction

Rousseaux

Cassim

Bayle

et al. 1999

Stroke

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Background-The aim of the study was to assess the consequences of severe spinothalamic tract lesions resulting from lateral medullary infarct and to show that a specific pain perception can be elicited by strong thermal stimulation. Case Descriptions-Both patients examined presented with severe thermoalgic dissociation of the limbs contralateral to the lesion, with normal discriminative somatosensory perception and motor strength. They reported pain perception when touching very warm (Ͼ50°C to 60°C) objects and a brisk, occasionally uncontrolled withdrawal reaction of the arm and hand under the same conditions, without any perception of the heat nature of the stimulus. Warm stimulation, Ͻ45°C, elicited no thermal perception or discrimination. Pain perception could be elicited in both patients by increasing the temperature, with a reproducible threshold of 47°C to 49°C. Pain always occurred after a prolonged delay of 8 to 10 seconds in response to threshold heat, and was described as deep and osseous, and clearly different from that perceived on the nonaffected side. The delay was much shorter when the temperature was increased by 4°C to 5°C. Cold stimulation elicited similar pain perception in one patient. Analysis of subjective perception of laser stimulation showed a much higher pain threshold on the affected hand. There were no laser-evoked potentials on this side, which suggested major spinothalamic injury. Assessment of the RIII noxious reflex revealed persistent response withdrawal reactions, with an increased threshold on the affected side, and partial consciousness of the noxious nature of the stimulus. Conclusions-To

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