Teaching NeuroImages: Acute infarction of the left medial lemniscus masquerading as a peripheral neuropathy

A 58-year-old woman with hypertension and bilateral carpal tunnel syndrome presented with acute paresthesias in her right hand and foot. She had decreased sensation to vibration and pinprick in a right-sided stocking-glove distribution. MRI of the pons confirmed an acute infarction of a paramedian branch of the basilar artery in the left medial lemniscus (figure). In the posterior column pathway, sensory projections from the face, arm, and leg are somatotopically arranged medially to laterally within the medial lemniscus.1,2 Although strokes classically present with numbness, both thalamic and medial lemniscal infarcts can explain acute hemidysesthesias.

Source: Neurology - April 24, 2017 Category: Neurology Authors: Aamodt, W. W., Siegler, J. E., Elman, L. Tags: MRI, DWI, All Cerebrovascular disease/Stroke, Central pain, Infarction RESIDENT AND FELLOW SECTION Source Type: research