Hemicape-like sensory disturbance caused by cortical infarction in the postcentral gyrus

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.