Unravelling the deception: identifying cheiro-oral syndrome in the emergency department--case reports

Patients with cheiro-oral syndrome (COS) often present with minor perioral and upper extremity sensory disturbances, which can be easily overlooked in busy emergency departments (EDs). [1]COS, a rare spectrum of stroke syndromes, necessitates expeditious and aggressive modification of risk factors.Any delay in treatment may result in severe disabilities due to an increased risk of recurrent strokes. [2]Here, we report two cases of COS, describing its unique clinical features, alongside investigations and management.Case 1, a 72-year-old woman with significant vascular risk factors, including diabetes mellitus, hypertension, hyperlipidaemia, ischaemic heart disease and cervical spondylosis, presented to the ED with complaints of recurrent perioral numbness and numbness in the tips of left thumb, index, and middle fingers for four days.She denied experiencing headache, dizziness, facial droop, dysarthria, dysphagia, weakness, or numbness in her limbs.Initially attributing her symptoms to cervical spondylosis as advised by her orthopaedic surgeon during her last follow-up, she sought medical attention immediately after being alerted by her physiotherapist, who emphasized that her perioral numbness was inconsistent with symptoms of cervical spondylosis.Upon physical examination, she was hypertensive at 161/75 mmHg (1 mmHg=0.133kPa).She exhibited reduced sensation to pin prick by 30% over the left trigeminal nerve V2 and V3 distribution, with no neurological deficits noted in the rest of the cranial nerves.Muscle power in both the upper and lower limbs was full, and sensation was intact.Muscle tone was also normal, and no abnormal reflexes were elicited.She had no dysmetria or dysdiadochokinesia.Laboratory tests were unremarkable.Non-contrast computed tomography (CT) of the brain revealed no acute haemorrhage or established large territorial infarction.She was admitted to the Neurology Stroke Unit for further