Sacral pseudoradiculopathy due to centrum semiovale stroke

Lesions affecting localized regions of the cerebral cortex may result in pseudoperipheral neurologic deficits. Such deficits have not been reported in association with subcortical lesions. A 60-year-old man with a history of hypertension presented with an acute sacral pseudoradiculopathy corresponding to an S1-S2 dermatomal distribution. The presence of hyperreflexia in the affected limb suggested an intracranial lesion. A brain magnetic resonance imaging scan revealed an isolated, small area of infarction localized to the centrum semiovale deep to the primary motor and sensory cortices. This case serves to illustrate that stroke can mimic a sacral radiculopathy. The distribution of the present patient's sensory disturbance suggests that thalamocortical projections maintain a dermatomal organization as they pass through the centrum semiovale.