Isolated facial sensory loss may be the result of ischemic stroke of the ventroposteromedial nucleus. Diffusion-weighted imaging (DWI) may depict this exceedingly unusual pure sensory stroke presentation.
A 73-year-old woman with hypercholesterolemia presented with acute onset of left lower facial tingling numbness without weakness. She delineated a discrete region of mild numbness around the left corner of her lips (Figure 1). On admission, DWI revealed a single punctate (5 mm) focus of restricted diffusion within the midportion of the right thalamus consistent with a small subacute lacunar infarct (Figure 2). There were also chronic scattered areas of abnormal T2 hyperintensity involving the subcortical and deep white matter of the cerebral hemispheres and pons. Magnetic resonance angiography was normal. After 1 day of antiplatelet therapy and hydration, her symptoms subsided.
Chen LL, Youssof S, Karanjia N, Liebeskind DS. Isolated Facial Sensory Loss in Stroke Restricted to the Ventroposteromedial Nucleus. Arch Neurol. 2008;65(7):977-978. doi:10.1001/archneur.65.7.977