SENSORY DISTURBANCES IN CORTICAL WOUNDS WITH SPECIAL REFERENCE TO PAIN

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Abstract
17 cases of traumatic cortical brain injury with sensory impairment, including 11 with impairment of pain sense, 2 with persistent hyperpathia, 2 with dissociation of pain and temp., 2 with impaired position sense and 2-point discrimination with preserved pain sense and also 1 with pain loss due to cortical neoplasm are described in detail. A larger series was examined less extensively. Position sense and 2-point discrimination were frequently dissociated. Both anatomical and physiol. evidence suggest cortical and thalamic interdependence on an equal basis rather than cortical domination. Recovery of pain sensation after extensive cortical loss, in contrast to failure of recovery after smaller areas of cortical loss is interpreted to be due to a shift to contralateral cortico-thalamic pathways, in the absence of any cortico-thalamic feed-back from the areas of the cortex to which the pain impulses were initially dispersed by the thalamus. The discriminative sensibilities do not similarly return because they are higher and more specific aspects of sensory function. The cortex is involved in the appreciation of pain but does not represent an "end-station" or a "highest level.".