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was normal except for hyperlipidemia and hyperglycemia. A brain MRI performed several hours later revealed an acute small ischemic lesion at the right midfrontal gyrus and chronic ischemic lesion at the right parietal lobe on diffusion-weighted images and T 2 -weighted images ( fig. 1 ). Carotid and vertebral arteries were normal at MR angiography. 24-hour Holter monitoring showed rare atrial and ventricular premature complexes and M-mode and twodimensional echocardiographies showed ischemic cardiomyopathy with mild systolic dysfunction and moderate aortic reDear Sir, Cheiro-oral syndrome (COS) is a wellknown sensory disturbance which affects the unilateral hand and mouth regions. Since Sitting’s initial report [1] , an increasing number of cases of COS have been reported [2] . In most cases of cortical COS the lesion was extended to the postcentral gyrus as a primary sensory cortex, but the lesion of the precentral gyrus causing COS was described in previous reports [3–5] . We describe a case with COS due to a frontal infarction and discuss the pathogenesis of frontal COS.

Cheiro-Oral Syndrome in a Patient from a Cortical Infarction in the Midfrontal Gyrus