We report a case of a small cortical
infarction in the postcentral gyrus that presented an isolated hemicape-like sensory disturbance. A 47-year-old man suddenly developed
numbness and
paresthesia in the left neck, shoulder, arm, and upper trunk. Examination revealed
hypoesthesia to touch and
pain in these areas along with a hemicape-like distribution. The sensitivity to cold and vibration was normal, and two-point discrimination and graphesthesia were preserved. The patient had a normal visual field, muscle strength, and reflexes, and there were no neuropsychological deficits. Magnetic resonance imaging (MRI) demonstrated a fresh, small
cerebral infarction in the right postcentral gyrus, which was superior medial to the precentral knob. The area of
infarction in this patient corresponds well with the area of the upper trunk, neck, head, shoulder, and arm in the sensory homunculus drawn by Penfield and Rassumussen. The spinal MRI was normal. Transesophageal echocardiography disclosed a
patent foramen ovale with a right-to-left-shunt. The patient was diagnosed as having acute
cerebral infarction, probably due to
paradoxical embolism, and was treated with
warfarin. A small localized
infarct in the postcentral gyrus can present an isolated sensory disturbance with an atypical hemicape-like distribution.