Sensory Cortical Lesion

Acutely in pure cortical lesions all modalities are affected; however, the modalities of deep sensation (proprioception and discriminative touch) tend to be involved more than the superficial sensory modalities. Vibratory sensation is the exception. Head noted that vibratory sensation was consistently diminished with lesions of the sensory cortex albeit mildly as compared with peripheral lesions. y With time, pain, touch, and temperature tend to return. The sense of discriminative touch is usually permanently and severely impaired.

There is generally unilateral loss of these modalities. When the loss is over one entire half of the body with cortical lesions the limbs are almost invariably more involved than the face or trunk. This is partly because in the limbs loss of spatial perception is usually the most prominent feature, whereas the face and trunk are poorly endowed with sensibility of this quality.

As the lesion becomes more superficial it would have to be increasingly large to affect all the diverging fibers. Superficial lesions, therefore, tend to affect one localized area only. The sensory disturbances are usually more marked in the distal than in the proximal segments of the limbs, probably owing to wider representation in the cortex.

Responses are characteristically variable from moment to moment. There is not a definite or sharp border, as the sensory loss generally fades away gradually into the region of normal sensibility. The different parts of the body do not regain their sensibility at the same rate. The face regains it fastest, especially the oral region, larynx, and anogenital region. The distal parts of the extremities have restitution that is far from complete. Patients with cortical lesions may also experience sensory phenomena like the inability to recognize their own limbs, or alien hand syndrome.

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