Representation of somatosensory modalities in pathways ascending from the spinal anterolateral funiculus to the thalamus demonstrated by lesions in man

Abstract

Patients with cordotomies (16), and brainstem (17) or thalamic (30) infarcts, all except cordotomies verified by magnetic resonance imaging (MRI), have been subjected to quantitative sensory perception threshold testing (QST) for touch (von Frey), mechanical pain, sharpness, innocuous warmth and cold, and heat pain in the maximally affected body area and its unaffected contralateral mirror image region. Some patients were tested twice at widely spaced time intervals; no qualitative differences were found. Results show that all modalities are dissociable from one another by lesions at all levels tested, so that there must be separable representation for each of the six modalities tested. In the lower (crossed symptoms and signs), but not the upper (uncrossed symptoms), deficits for all modalities (except for touch) were more marked than at higher levels. At the level of the thalamus, deficits for innocuous and noxious thermal modalities but not for mechanical pain were recorded in the case of lesions of the principal somatosensory relay nucleus (VPL/Vc), while more medial thalamic lesions resulted in deficits for mechanical pain but not for heat pain or innocuous thermal modalities; there is a marked deficit for sharpness caused by lesions at both thalamic sites.