Cheiro-oral syndrome usually results from acute small vessel disease w
ith expected favorable outcome. Simultaneous ipsilateral perioral and
hand involvement may be not only due to anatomic proximity but also du
e to differential sensory threshold. A separate compensatory physiolog
ic mechanism may explain the rarity of slower evolving lesions in prod
ucing the cheiro-oral syndrome. Cerebral abscess, surgically treatable
with subacute presentation, may produce an identical clinical syndrom
e.