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A 61 year old female was involved in a car accident 3 years ago and sustained a depressed fracture of the skull on the right temporofrontal forehead.In the early course of the injury, she noticed the disturbance of the temperature sensation on the right half of her face, and the left extremities and the left half of the body alternately.Such was considered to be the appearance of the hemianesthesia alternans.After several months, she was found to have a central pain with hyperpathia on the same areas, namely the development of the hemianesthesia dolorosa alternans.The mode of the appearance of the thalamic pain was considered to be as follows.At the time of the accident, both the spinothalamic and trigeminothalamic tracts were damaged by injury at the level of the right upper side of the pons.Each of these tracts would have gradually degenerated retrogradelly up to each nerve cell in the posteroventral nuclei in the thalamus.In these nuclei the nerve cells involved in pain-temperature sensation are assumed to be present and have an inhibitory effect on the nuclei of the intralaminar zone in the thalamus.When the former cells eventually degenerate, there would be no inhibition on the latter cells and such would in the usual manner. Thus the thalamic pain would gradually appear several months after the accident.

A Case Report of Trigeminal Hemianesthesia Alternans with Thalamic pain from the Point of View of the Otoneurologic Examination