Beena Vasanthy Vijayan, Gourisankar Peringattu Thankappan Nair, Vijayan Chandrathil Parameswaran Nair
BACKGROUND A fifty-two-year-old man presented with acute onset right lower facial and ear numbness and facial weakness, after two weeks of the onset of symptoms. Examination revealed right central facial palsy, depressed corneal reflex and hemifacial sensory loss (mild over forehead, severe over lower cheek, jaw & pinna) Localization was proposed in brainstem Vs Cerebellopontine angle. MRI Brain revealed infarct in peri Rolandic area; four more patients had similar presentation over next few years.1 Core findings were ipsilateral graded facial sensory impairment with central facial palsy, ear involvement & impaired corneal reflex. Four had spastic hand. Hypothesis- Cortical lesions can have LMN- like presentation; impairment of facial and external ear (pinna) sensations, and attenuated corneal reflex. MATERIALS AND METHODS Settings and Design- Patients presenting to the Neurology OPD with facial weakness and isolated sensory loss of face were admitted and evaluated with detailed neurological examination, including facial & ear sensations and corneal reflex; Stroke work up & MRI Brain with MRA was done. They were treated and kept under follow up. RESULTS Patients with post central gyrus infarct had uniformity in presentation, graded sensory loss over face, depressed corneal reflex & ear involvement, had uniformity in presentations and medical help seeking usually were delayed. Two had lower face (mandibular region) severely affected; while three had maxillary involvement. Spastic hand weakness was found in four. CONCLUSION Cortical lesions can produce LMN-like sensory phenomena, of face. Corneal reflex abnormality & ear involvement occur in cortical lesions. Ear representation is closer to lower face in sensory cortex. Four out of five patients had spastic hand in this series. Hence in spastic hand due to cortical lesions, triad of sensory findings should be specifically elicited.
