Midlateral medullary infarction presenting with isolated thermoanaesthesia: a case report

Hanada, Keisuke; Yokoi, Kayoko; Kashida, Natsuko; Shimomura, Ryota; Murata, Daiki; Hirayama, Kazumi

doi:10.1186/s12883-022-02796-x

BMC Neurology

Table 2 Somatosensory Test Results

From: Midlateral medullary infarction presenting with isolated thermoanaesthesia: a case report

Tests	Result
	Left		Right
	Upper extremity	Lower extremity	Upper extremity	Lower extremity
a. Basic somatosensory modalities
Pain sensation	Back of the hand	Back of the foot	Back of the hand	Back of the foot
Threshold (load on pin [g]; range: 1–20)	6	6	6	6
Right-side pain stimulus perceived as equivalent to the left [g] (left side at 8 g)			8	8
Temperature sensation	Back of the hand	Back of the foot	Back of the hand	Back of the foot
Discrimination of warm, cold, noxious hot, and noxious cold stimuli (40 °C, 10 °C, 50 °C, 0 °C respectively) Number of positive responses out of three attempts; max: 12)	12	12	12	12
Noxious hot sensation (50 °C)	+	+	+	+
Noxious cold sensation (0 °C)	+	+	+	+
Threshold [°C] (temperature changed at ~0.1 °C/sec. Average of three attempts)
Threshold for warmth	38.6	36.3	33.0	32.0
Threshold for cold	28.6	28.3	29.6	27.3
Right-side temperature stimulus perceived equal to the left-side stimulus [°C]
Left at 25 °C			26	27
Left at 40 °C			33	34
Left at 10 °C			18	33
Tactile sensation
Semmes–Weinstein Monofilament [9] (range: 1.65–6.65) ^d	3.22 at all sites	3.22 at all sites	3.22 at all sites	3.22 at all sites
Vibratory sense ^e	normal	normal	normal	normal
Joint position sense (number of correct answers; max: 20) ^f	20	20	20	20
b. Cortical somatosensory modality
Two-point discrimination (mm)
Stimulation of the middle finger tip	3		3
Stimulation of the big toe ball		30		20
Size comparison (number of correct answers; max: 6) ^g	6		6
Weight comparison (number of correct answers; max: 6) ^a	6		6
Identification of geometric shapes (number of correct answers; max: 6) ^b	6		6
Identification of everyday items (number of correct answers, max: 12) ^c	12		12

Abnormal values have been indicated in bold. max: maximum.
^a From a group of weights of 10 g, 30 g, 50 g, 70 g, 90 g, 110 g, and 130 g of the same size, the patient received two of adjacent weights (e.g., 10 g and 30 g) to hold in succession and was asked to report which was heavier.
^b From a group of shapes consisting of a sphere, circular cone, cylinder, cube, triangular prism, and hexagonal column, the patient received one shape to handle in a location shielded from the patient’s view. Subsequently, all shapes were shown to the patient, and she was asked which shape she had handled.
^c The patient was given a ball-point pen, scissors, spoon, clothes peg, golf ball, or stapler to handle in a location shielded from the patient’s view. Then, the patient was asked to name the item.
^dThe ball of the thumb, each fingertip, and the ball of the toe were stimulated.
^eThe patient was asked to report whether a 128 Hz tuning fork was vibrating when touched by it. By gradually reducing the amplitude of the tuning fork, the patient was evaluated for left-right differences of the smallest detectable amplitude. The ulnar styloid and index proximal interphalangeal joint were stimulated.
^fJoints were moved through approximately 10% of the joint range of motion.
^gFrom a group of square leather pieces with side lengths of 40 mm, 45 mm, 50 mm, 55 mm, 60 mm, and 65 mm, the patient received two pieces of adjacent sizes (e.g., 40 mm and 45 mm) to touch in succession and was asked to report which was larger.

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