Universal dissociated anesthesia due to bilateral brain-stem infarcts.

Area of Science:

• Neurology
• Neuroscience
• Clinical Neurology

Background:

• Dissociated sensory loss typically involves specific nerve tracts.
• Bilateral brainstem lesions are uncommon causes of widespread sensory deficits.

Observation:

• A 59-year-old man presented with loss of pin-prick and temperature sensation across his entire body.
• Preserved sensations included light touch, vibration, proprioception, and deep pain.
• Neurological examination revealed truncal and limb ataxia without motor weakness.

Findings:

• The patient's symptoms were attributed to sequential infarctions in the right superior cerebellar artery and left posterior inferior cerebellar artery territories.
• This pattern suggests bilateral, discrete interruption of spinothalamic and trigeminal spinal tracts in the brainstem.
• This specific combination of widespread sensory loss and preserved deep pain is previously unreported.

Implications:

• This case highlights a unique syndrome of bilateral brainstem tract interruption.
• It underscores the importance of considering vascular events in the brainstem for complex sensory disturbances.
• The dissociation between cutaneous and deep pain sensation warrants further investigation into pain processing pathways.