Sensorimotor stroke

Toni D, Del Duca R, FiorelU M, Sacchetti ML, Bastianello S, Giubilei F, Martinazzo C, Argentino C. Pure motor hemiparesis and sensorimotor stroke accuracy of very early clinical diagnosis of lacunar strokes. Stroke 1994 25(l) 92-96. 

While physicians may not recognize up to 80% of lacunes (Tuszynski et al. 1989), several clinical syndromes have been correlated with relevant lacunes detected at subsequent autopsy. Five of these are regarded as the classic lacunar syndromes pure motor hemiparesis, sensorimotor stroke, pure sensory hemiparesis, dysarthria clumsy hand syndrome, and ataxic hemiparesis (Donnan et al. 2002 Fisher 1982 Bamford 2001). Pure motor stroke is the commonest lacunar syndrome in clinical practice, while pure sensory stroke is encountered less frequently. The involvement of the face, arm and leg of one side is the characteristic feature of the first three syndromes while reductions of consciousness, cognitive or visual field defects are absent. Even though lacunar infarcts have been linked to lacunar syndromes, the latter are of course not specific for this stroke subtype and mimicked by cortical infarcts, intracerebral hematomas, and non-vascular causes (Bogousslavsky et al. 1988 Bamford 2001). 

Sensorimotor stroke constitutes about 35% of cases. It is the combination of a pure motor stroke with sensory signs in the affected body parts. The lesion is usually in the thalamus or internal capsule, but it can be in the corona radiata or pons. A similar clinical picture can be caused by cortical infarcts, leading to misclassification (Blecic et al. 1993). 

Small thalamic lesions may cause a pure sensory stroke or sensorimotor stroke, sometimes with ataxia in the same limbs (Schmahmann 2003). However, other deficits may occur in isolation, or in combination depending on which thalamic nuclei are involved. These include paralysis of upward gaze, small pupils, apathy, depressed consciousness, hypersomnolence, disorientation, visual hallucinations, aphasia and impairment of verbal memory attributable to the left thalamus, and visuospatial dysfunction attributable to the right thalamus. Occlusion of a single small branch of the proximal posterior cerebral artery can cause bilateral paramedian thalamic infarction with severe retrograde and anterograde amnesia. 

Blecic SA, Bogousslavsky J, van Melle et al. (1993). Isolated sensorimotor stroke a re-evaluation of chnical topographic and aetiological patterns. Cerebrovascular Diseases 3 357-363... 

Schallert T, Fleming SM, Leasure JL, Tillerson JL, Bland ST (2000) CNS plasticity and assessment of forelimb sensorimotor outcome in unilateral rat models of stroke, cortical ablation, parkinsonism and spinal cord injury. Neuropharmacology 39 111-1% . 

Despite the limitations of fMRI outlined above, fMRI studies have shown similar findings to those of positron emission tomography studies in recovery after stroke (Yozbatiran and Cramer 2006 Rijntjes 2006). Increased ipsilateral primary sensorimotor cortical activity with posterior displacement of the ipsilesional focus of activity, bilateral supplementary motor area activation and premotor cortical activation occurs after stroke with use of the affected hand in comparison with use of the unaffected hand (Weiller et al. 1992 Cramer et al. 1997 Cao et al. 1998 Pineiro et at 2001). Specifically, in patients with capsular or other subcortical stroke, good recovery is related to enhanced recruitment of the lateral premotor cortex of the lesional hemisphere and lateral premotor and, to a lesser extent, primary sensorimotor and parietal cortex of the contralateral hemisphere (Gerloff et al. 2006). 

Jung KH, Chu K, Jeong SW, Han S Y, Lee ST, Kim JY, Kim M, Roh JK (2004) HMG-CoA reductase inhibitor, atorvastatin, promotes sensorimotor recovery, suppressing acute inflammatory reaction after experimental intracerebral hemorrhage. Stroke 35 1744—1749. 

Hesse, S., Kuhlmann, H., Wilk, J., Tomelleri, C., Kirker, S.G.B. A new electromechanical trainer for sensorimotor rehabilitation of paralysed fingers a case series in chronic and acute stroke patients. Journal of Neuroengineering and Rehabilitation 5, 21 (2008)... 

Volpe, B.T., Krebs, H., Hogan, N., Otr, L., Diels, C., Aisen, M. A novel approach to stroke rehabilitation robot-aided sensorimotor stimulation. Neurology 54, 1938-1944... 

B. Volpe, H. Krebs, N. Hogan, L. Edelstein OTR, C. Diels, and M. Aisen (2000), A novel approach to stroke rehabilitation Robot-aided sensorimotor stimulation. Neurology 54 1938-1944. 

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