Pure sensory syndrome occurs after a cerebral infarction in the thalamus, A structure of vital importance for filtering sensory information, and causes, among other symptoms, paralysis and loss of feeling in the middle of the body.
In this article, we explain what pure sensory syndrome is, what are its main causes, what symptoms it causes and what treatment to follow.
What is pure sensory syndrome?
Pure sensory syndrome is one of the classic lacunar syndromes better defined by the physician Charles M. Fisher, One of the first neurologists to study and contribute to the understanding of stroke, particularly those related to carotid artery disease and lacunar infarction.
In clinical practice, lacunar syndrome is understood to mean any clinical manifestation in which a lacunar-type cerebral infarction occurs.
This type of heart attack they are characterized by the presence of tiny lesions (No more than 15 mm in diameter) caused by occlusion of small branches of the perforating arteries of the brain.
Pure sensory syndrome constitutes 7% of lacunar infarcts and people who suffer from it have sensory symptoms, persistent or transient, which affect half of the body.
Little is known about the frequency of occurrence of the different forms of the syndrome., Which include: complete hemisensitive syndrome (with sensory impairment that encompasses the entire facio-brachio-crural axis, ie the face, arm and leg on one side of the body); and incomplete hemisensitive syndrome (less specific and with different clinical variations).
The most common cause of pure sensory syndrome includes lacunar thalamus infarction, although it may also be secondary to intracerebral hemorrhage or cortical injury to the internal, parietal, mesencephalic, or pontine capsule (related to the bulge or bridge, structure located at the base of the brain).
There is not yet much information regarding the different types of lacunar infarcts that can cause pure sensory syndrome, as well as the differences between lacunar and non-lacunar type strokes.
However, studies show that in 80 to 90% of cases, the cause of pure sensory syndrome is lacunar infarction; and in the remaining 10% of cases, the causes would be varied, including atherothrombotic infarctions, primary intracerebral hemorrhages and other infarctions of unknown etiology.
Causes of pure sensory syndrome a series of sensory symptoms that typically affect the face, arm, and leg on one side of the body (Facio-brachio-crural hemi-hypoesthesia).
The most common symptoms are: hypoesthesia (reduced sensitivity) isolated without motor compromise, paralysis on one side of the body or hemiplegia, Dysarthria (difficulty in articulating sounds and words), nystagmus (uncontrollable and involuntary movement of the eyes) and visual or cognitive defects (alterations in executive functions, such as semantic fluency or short-term verbal memory).
This lacunar syndrome too may be associated with neuropathic-type disease, And epicritic sensitivity (which distinguishes both the quality and location of a sensory stimulus), protopathic sensitivity (as opposed to epicritic), or both may be affected.
Other symptoms such as paresthesia (numbness and tingling in the body, mainly the extremities) are often rare, as is isolated proprioceptive loss, which involves the ability to know the relative position of the body and muscles at all times. .
The hypoaesthesia that occurs in pure sensory syndrome can be faciobrachial, facio-brachio-crural, facio-crural, or trunk and crural, with frequent thalamic topography, and that occurs in the fingers may be associated with cortical wall damage. Other models with this same symptom have also been linked to brainstem damage.
One of the maxims when treating pure sensory syndrome and, in general, any type of lacunar infarction, is intervene in time. This means that treatment must be urgent, as the first few hours after the stroke are crucial, and a difference in hours can mean whether or not the patient survives.
After a heart attack, instead, the person should be taken to the nearest hospital to start treatment as soon as possible (within the first 3 hours after injury), usually using anticoagulant drugs that clear the blockage and allow the blood supply to flow normally again Brain surgery is sometimes necessary, but it is not common.
Once operated, the patient you will need to start rehabilitation which includes visits from different professionals from various branches of health.
Physiotherapy and medical follow-up
The function of the physiotherapist is to help the patient to restore motor functions, mainly by performing exercises with the affected joints. The professional should be especially careful not to cause additional complications in the patient’s body and limbs, which will be very weak after the heart attack.
For his part, the specialist doctor (neurologist, in this case) will be responsible for monitoring any neurological complications and may request any type of test required (computed tomography, MRI, etc.).
The role of the neuropsychologist in these cases is to rehabilitate higher cognitive functions that have been affected. In lacunar infarcts, for example, executive functions may be affected, which are responsible for planning, reviewing and evaluating complex information that enables the individual to adapt to the environment and effectively achieve milestones.
The neuropsychologist, through the application of individualized programs and the execution of specific tasks, will help the patient to restore and / or compensate for the cognitive deficits caused by the injury, so that the person regains his autonomy and can become functional again. areas of his life (family, work and social).
Occupational therapy and psychotherapy
The main goal of occupational therapy is allow the patient to participate in activities of daily living. The job of the occupational therapist is to allow the individual, after the recovery period, to be able to modify his environment so that he can participate again in social and community activities.
Psychological therapy will be at the service of the patient to improve skills that have been diminished and to recover from emotional damage which such a disorder causes in the patient and his immediate environment. The psychologist must provide the patient with the necessary tools to achieve that psychological well-being and vital balance that everyone needs after a process like this.
- Arboix, A., García-Plata, C., García-Eroles, L., Massons, J., Comes, E., Oliveres, M., and Targa, C. (2005). Clinical study of 99 patients with pure sensory stroke. Journal of Neurology, 252 (2), 156-162.
- Fisher CM (1965) Pure sensory race with face, arm and leg. Neurology 65:76 – 80.
- Grau-Olivares, M., Arboix, A., Bartrés-Faz, D., and Junqué, C. (2004). Neuropsychological alterations in cerebral infarction of the lacunar type. Mapfre Medicine, 15 (4), 244-250.