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Hemiataxia-hypesthesia in thalamic hemorrhage. Significance of sensory deficit patterns and presence or absence of weakness.

Hemiataxia-Hypesthesia in Thalamic Hemorrhage Significance of Sensory Deficit Patterns and Presence or Absence of Weakness Ji Hoe Heo, MD, Department of Neurology, Yonsei University College of Medicine, CPO Box 8044, Seoul (Korea) Hemiataxia-hypesthesia without weakness has rarely been reported in thalamic hemorrhage [1–3]. We report 2 patients with thalamic hemorrhage who showed hemiataxia-hypesthesia without weakness and who demonstrated different patterns of sensory deficit. We also discuss the significance of sensory deficit patterns as well as the significance of the presence or absence of weakness towards localizing a thalamic lesion. Case Reports Patient 1. A 59-year-old right-handed hypertensive man had sudden loss of consciousness for 2 h. His case history included an operation 12 years prior due to an aneurysmal rupture, and an intracerebral hemorrhage 2 years prior, which had resulted in minimal right spastic hemiparesis. Two days later, at admission, he complained of headache, dizziness, and blurred vision. He was alert and well oriented, but showed dysarthria. Although there were mild ptosis and miosis in the left eye, both pupils were reactive to light. Skew deviation was noticed, and the right eyeball was limited in its ability to gaze upward. Muscle power and tone were both normal throughout the left side of his body. Although a sensory examination revealed a mild decrease in pain and light touch sensations on the left side of his body, position and vibration sensations were normal. He showed a tendency to fall to the left side. Both the finger to nose test and the heel to shin test revealed marked incoordination and terminal tremor on his left side. Rapid alternate movement in the left hand was severely impaired. A brain CT scan revealed a hemorrhage in the right thalamus (fig. la). The patient improved gradually. One year later, he showed mild hypesthesia and moderate cerebellar ataxia on his left side. Patient 2. A 67-year-old right-handed diabetic man developed sudden headache, dizziness, numbness in the left hand, and equilibrium disturbance. Three days later, at admission, muscle power, deep tendon reflexes, and muscle tone were normal. But sensory examination revealed a slight decrease in pain, light touch, position and vibration sensation on his left side. Rapid alternate movement in the left hand showed mild dysdiadokokinesia. He showed a tendency to fall to the left side during straight-line walking tests. A brain CT scan revealed a hemorrhage in the right thalamus (fig. lb). Two weeks later, he showed neither dysdiadokokinesia nor a tendency to fall. A sensory examination revealed improved but still mild left hemihyp-esthesia. Discussion Our 2 patients showed hemiataxia-hypesthesia without weakness, although the clinical picture of patient 1 included thalamic-subthalamic dysfunction. Interestingly, they showed different patterns of sensory deficits. Patient 1 revealed a reduction in pain and touch