Neurological Research
A Journal of Progress in Neurosurgery, Neurology and Neuro Sciences

ISSN: 0161-6412 (Print) 1743-1328 (Online) Journal homepage: http://www.tandfonline.com/loi/yner20

Cheiro-pedal syndrome following pontine
infarction
Osamu Igarashi, Joe Aoyagi, Yuji Kawase, Tetsuhito Kiyozuka, Kiyokazu
Kawabe, Yasumitsu Ichikawa, Hiroaki Iguchi, Toshiki Fujioka, Ken Ikeda &
Yasuo Iwasaki
To cite this article: Osamu Igarashi, Joe Aoyagi, Yuji Kawase, Tetsuhito Kiyozuka, Kiyokazu
Kawabe, Yasumitsu Ichikawa, Hiroaki Iguchi, Toshiki Fujioka, Ken Ikeda & Yasuo Iwasaki (2005)
Cheiro-pedal syndrome following pontine infarction, Neurological Research, 27:1, 103-104
To link to this article: http://dx.doi.org/10.1179/016164105X18412

Published online: 19 Jul 2013.

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Date: 30 March 2016, At: 19:20

Cheiro-pedal syndrome following pontine
infarction
Osamu Igarashi, Joe Aoyagi, Yuji Kawase, Tetsuhito Kiyozuka,
Kiyokazu Kawabe, Yasumitsu Ichikawa, Hiroaki Iguchi, Toshiki Fujioka,
Ken Ikeda and Yasuo Iwasaki

Downloaded by [Orta Dogu Teknik Universitesi] at 19:20 30 March 2016

Department of Neurology, Toho University Omori Hospital, 6-11-1 Omorinishi Ota-ku, Tokyo 143-8541,
Japan

We report the case of a 64-year-old man with sudden onset of numbness in the right hand
and foot. Neurological examinations were normal except for hypersthesia, and hyperalgesia of
the right hand and foot. Brain MRI demonstrated a high signal intensity on T2-weighted image
and a low signal intensity on T1-weighted image in the left tegmetum of the pons. He was
diagnosed with pontine infarction presenting with cheiro-pedal syndrome (CPS). Damage in the
sensory pathways can cause CPS. Difference in the threshold may explain the specific sensory
pattern in this syndrome. Further examination of the relationship between sensory symptoms and
localization on MRI is needed to clarify this syndrome. [Neurol Res 2005; 27: 103–104]
Keywords: Cheiro-pedal syndrome; brainstem infarction; medial lemniscus; threshold; somatotopy

INTRODUCTION
The cheiro-oral syndrome (COS) is a specific sensory
disturbance that affects the unilateral corner of the
mouth and ipsilateral hand1–4. In addition to COS,
sensory disturbance confined to the foot region has been
reported, a syndrome called cheiro-oral-pedal syndrome (COPS)4,5. It is well known that damage of
the sensory pathway can cause either COS or COPS.
Cerebral lesions exhibit mainly cheiro-oral topography1.
Thalamus and thalamocortical projection produce
cheiro-oral-pedal sensory disturbance4,5. Recently, patients
with restricted sensory changes in the palm and foot
[cheiro-pedal syndrome (CPS)] have been reported4.
We report a patient whose clinical manifestation are
specific sensory disturbance confined to the hand and
foot unilaterally in the same lesion, while MRI shows
infarction in the tegmentum of the pons.
CASE REPORT
A 64-year-old man with hypertension and diabetes
under poor control suddenly developed numbness in
the right hand and foot. He was admitted to our
department the following day. His blood pressure was
156/86 mmHg. General physical examinations were
normal. On neurological examination, consciousness
was alert. His cognitive ability and orientations were
normal, as were external eye movements without
nystagmus, other cranial nerves, motor functions and
deep tendon reflexes. Plantar responses were flexor.
Correspondence and reprint requests to: Yasuo Iwasaki, Department of
Neurology, Toho University Omori Hospital, 6-11-1 Omorinishi Otaku, Tokyo 143-8541, Japan. [yaso@med.toho-u.ac.jp] Accepted for
publication June 2004.

# 2005 W. S. Maney & Son Ltd

10.1179/016164105X18412

Cerebellar incoordination and involuntary movements
were not seen. There were hyperesthesia and hyperalgesia of the hand and foot in the right side.
T2-weighted MRI showed a high signal intensity in
the left tegmentum of the pons and the T1-weighted MRI
showed a low signal intensity in the same lesion
(Figure 1). The cheiro-pedal sensory disturbance gradually diminished in the course of 4 months with the same
intensity.
DISCUSSION
Restricted sensory disturbance in the palm and foot is
termed cheiro-pedal syndrome (CPS)4 and this was
considered to be the diagnosis in our case. Garcin and
Lapresle2,3 demonstrated that COS may result from a
small thalamic infarction between the lateral portion of
posteriomedial central nucleus and the inferior medial
portion of posterolateral ventral nucleus. Thalamocortical and brainstem lesions also cause COS5–9.
Otherwise, COPS could be explained by the partial
involvement of the medial lemniscus, thalamus or
thalamocortical projections10.
Kim4 reported 30 stroke patients presenting with
restricted sensory syndrome, including with COS, COPS
and CPS. The patients were COS in 10, COPS in eight,
CPS in four, restricted to palm and/or finger in seven,
and periotalpedal in one, respectively. In his report
concerning CPS, three had responsible lesions, either
lenticulocapsular or corona radiata, and only one
patient had infarct in the pons4. Considering the CPS
in the pontine lesion. Kim’s case had two consecutive
infarcts in the pons and presented with bilateral CPS.
Quadriparesis was also seen in his case. MRI of his case
showed infarcts identified from tegmentum to basis in
Neurological Research, 2005, Volume 27, January

103

Cheiro-pedal syndrome: Osamu Igarashi et al.

The difference in threshold may explain the specific
sensory pattern in the syndrome13. These sensory
symptoms may be attributable to differential detection
thresholds, possibly related to the partial involvement of
sensory nuclei or fibers having somatotopy. Further
examination of the relationship between CPS and
localization on MRI is needed to clarify the topographic
distribution of the sensory pathway.

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REFERENCES

Figure 1: T1-weighted MRI high signal intensity disclosed low signal intensity in the left tegmentum of the pons

the pons bilaterally4. In our case, motor functions were
normal and the responsible region was localized in the
pontine tegmentum. In the pons, the sensory fibers from
the mouth, arm and leg are located from the medial to
lateral side in the small area of the medial lemniscus11.
Therefore, our case indicated that sensory fibers
corresponding to the arm and leg in the medial
lemniscus was selectively involved. Yasuda et al.10
reported that thoracic sensory disturbance was presented with COS or COPS. However, trunkal sensory
impairment was not seen in our case.
Tasker et al.12 reported that in the thalamus the fore
limb and hind limb are considered to be located
between the areas for fingers and toes. However, the
anatomic proximity concept cannot fully explain the
selective sensory involvement of COS and COPS.

104 Neurological Research, 2005, Volume 27, January

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