SENSORY SYMPTOMS AND SIGNS AND RESULTS OF QUANTITATIVE SENSORY THERMAL TESTING IN PATIENTS WITH LACUNAR INFARCT SYNDROMES

Background and Purpose Quantitative data on sensory impairment in stro ke patients are limited. We measured the perception thresholds for tem perature and thermal pain in patients with different lacunar syndromes , correlated the results with clinical and magnetic resonance imaging (MRI) findings, and studied the long-term prognosis of sensory dysfunc tion. Methods Quantitative thermal testing was performed by means of t he Marstock method in 39 patients with lacunar syndromes (pure motor, sensorimotor, or pure sensory stroke) and MRI findings compatible with occlusion of a single perforating artery. Thresholds for cold, warmth , and heat pain were obtained bilaterally from the cheek, hand, and le g. The unaffected side was used as control. Follow-up included clinica l assessments and repeated quantitative thermal testing (in 17 patient s) up to 1 year after stroke onset. Results Patients with pure sensory stroke and sensorimotor stroke (n=22) had a significant thermal hypoe sthesia on the affected side for all modalities and test locations. Pa tients with pure motor stroke (n=17) exhibited thermal hypoesthesia fo r cold and heat pain in the hand and for cold perception in the leg. O n MRI, infarcts causing pure motor and sensorimotor stroke were predom inantly Ienticulocapsular, while a thalamic site of infarction was fou nd in pure sensory stroke. The prognosis of sensory impairment was fav orable, except for poststroke pain syndromes in three patients. Conclu sions Quantitative thermal testing confirmed an involvement of spinoth alamic pathways in lacunar infarcts causing pure sensory and sensorimo tor stroke and revealed a subclinical sensory impairment in patients w ith pure motor stroke. Infarction sites were similar in patients with pure motor and sensorimotor stroke.