Somatosensorische stoornissen in de subacute fase na een herseninfarct.

Abstract

Introduction. The somatosensory system is essential for providing a representation of our bodies, as well as about the (external) world. These functions are higher order, cognitive aspects of the somatosensory system. Somatosensory deficits after a stroke are known to be related to a reduced level of ADL functioning and a longer duration of stay and rehabilitation. Previous studies have focused particularly on the presence of primary somatosensory deficits, the current study therefore focuses mainly on investigating the frequency of higher order somatosensory deficits (external and body related) in the early stage after a stroke.

Methodology. Thirty hospital-based patients were examined using a battery of validated non-invasive neuropsychological tests in the early stage after the diagnosis of a cerebral stroke (within 2 weeks after stroke) in the University Medical Center Utrecht (UMCU) or in the Meander Medical Center Amersfoort.

Results. Primary tactile disorders were common after stroke; 43.3% of the patients had impairments. The primary tactile impairments were found in proprioception (25.9%, cl; 14.8%, il), pressure sensitivity (55.6%, cl; 22.2%, il), two point discrimination (38.1%, cl; 23.8%, il) and temperature discrimination (5.9%- 29.4%). For the higher order touch disorders, impairments were found in tactile object recognition (12.5%, cl; 3.8%, il), finger agnosia (17.9%) and body representation deficits (3.6%, cl; 16%, il). There are also significant correlations between the primary and high-order somatosensory functions. The performance of the patients on the somatosensory tasks appears to be affected by a lesion in the right hemisphere and/or having complaints about the sense of touch.

Conclusions. A clinically significant proportion of the patients show somatosensory deficits in the early stage following stroke. Recommendations for further research are to examine the relation between the primary and higher order touch disorders as well as the changes in frequency of these deficits in the chronic stage.