Foerster's syndrome

Overview

Foerster's Syndrome is a rare neurological condition named after German neurologist Otfrid Foerster. It is characterized by contralateral motor and sensory deficits resulting from lesions in the cerebral cortex, particularly affecting the motor and sensory cortical regions. The syndrome is primarily observed following cortical damage due to trauma, stroke, or tumors, and is often associated with abnormal reflexes, such as the reappearance of primitive reflexes and disturbances in voluntary movement and sensation.

Causes

Foerster's Syndrome is not a primary disease but rather a neurological presentation resulting from damage to the cerebral cortex. Known causes include:

• Stroke: Ischemic or hemorrhagic stroke affecting the motor and sensory cortices.

• Traumatic brain injury: Penetrating or blunt head trauma leading to cortical damage.

• Brain tumors: Particularly those located in or near the precentral and postcentral gyri.

• Neurosurgical procedures: Iatrogenic damage during brain surgeries in the affected region.

Symptoms

The hallmark of Foerster's Syndrome is the combination of motor and sensory deficits on the side of the body opposite to the site of cortical damage. Key features include:

• Contralateral hemiparesis or hemiplegia: Weakness or paralysis affecting one side of the body.

• Contralateral sensory loss: Diminished or absent sensation, including touch, pain, and temperature perception.

• Spasticity or hypertonia: Increased muscle tone on the affected side.

• Exaggerated deep tendon reflexes

• Positive Babinski sign: An abnormal plantar reflex indicative of upper motor neuron damage.

• Possible seizure activity if the lesion irritates surrounding cortical tissue.

Diagnosis

Diagnosis of Foerster's Syndrome is based on clinical neurological examination and neuroimaging studies. Diagnostic steps include:

• Neurological examination: Assessment of motor strength, sensory function, reflexes, and coordination.

• Magnetic Resonance Imaging (MRI): To detect cortical lesions, infarcts, hemorrhages, or tumors.

• Computed Tomography (CT) scan: May be used in acute settings to rule out hemorrhage or mass effect.

• Electrophysiological studies: Such as EEG, especially if seizures are suspected.

Treatment

Treatment of Foerster's Syndrome focuses on addressing the underlying cause of cortical damage and providing rehabilitative support. Common treatment strategies include:

• Medical or surgical management of the underlying cause (e.g., stroke treatment, tumor resection).

• Physical therapy: To improve motor function and prevent contractures.

• Occupational therapy: Aiding in regaining independence in daily activities.

• Speech and language therapy: If speech or swallowing are affected.

• Medications: Such as muscle relaxants for spasticity, anticonvulsants for seizures, and pain management drugs for sensory disturbances.

Prognosis

The prognosis of Foerster's Syndrome depends on the extent and cause of cortical damage. Some patients may experience partial or full recovery, particularly with early and intensive rehabilitation. However, if the cortical injury is extensive or progressive (e.g., due to malignancy), permanent deficits may persist. Long-term outcomes are improved by multidisciplinary care and consistent rehabilitative support.