Skip to main content
Top
Published in: Journal of Neurology 7/2009

01-07-2009 | Original Communication

Ischemic stroke of the cortical “hand knob” area: stroke mechanisms and prognosis

Authors: Nils Peters, Stefanie Müller-Schunk, Tobias Freilinger, Marco Düring, Thomas Pfefferkorn, Martin Dichgans

Published in: Journal of Neurology | Issue 7/2009

Login to get access

Abstract

Cortical ischemic stroke affecting the precentral “hand knob” area is a rare but well known stroke entity. To date, little is known about the underlying stroke mechanisms and the prognosis. Twenty-nine patients admitted to our service between 2003 and 2007 were included in the study on the basis of an acute ischemic infarct of the cortical “hand knob” area confirmed by diffusion-weighted magnetic resonance imaging with contralateral hand paresis. For all patients clinical, epidemiological as well as imaging data at the time point of admission were analysed retrospectively and follow-up data on all patients was obtained. The majority (n = 21/72%) had an isolated infarct of the cortical “hand knob” area. In 23 (79%) patients it was a first ever stroke. Ten patients (34%) had ipsilateral extracranial stenosis of the internal carotid artery (ICA), whereas potential cardiac embolic sources were less frequent (n = 4/14%). No patient exhibited ipsilateral MCA stenosis. All but two patients (93%) had marked atherosclerotic alterations of the ICA. Hypertension was the most prevalent vascular risk factor (n = 23/79%). At follow-up (mean 25.0 months, range 0.4–47.4 months) no patient had died and only one (3%) experienced a recurrent stroke. The majority of patients (79%) reported improvement of hand paresis, 17 (59%) were asymptomatic (modified Rankin score = 0). Only one patient was significantly disabled due to a recurrent stroke. In conclusion, ischemic infarcts affecting the cortical “hand knob” area are frequently associated with atherosclerotic changes of the carotid artery, suggesting an arterio-arterial thrombembolic stroke mechanism. It mostly reflects first ever ischemic stroke, and follow-up data suggest a rather benign course.
Literature
1.
go back to reference Yousry TA, Schmid UD, Alkadhi H, Schmidt D, Peraud A, Buettner A, Winkler P (1997) Localization of the motor hand area to a knob on the precentral gyrus. A new landmark. Brain 120:141–157PubMedCrossRef Yousry TA, Schmid UD, Alkadhi H, Schmidt D, Peraud A, Buettner A, Winkler P (1997) Localization of the motor hand area to a knob on the precentral gyrus. A new landmark. Brain 120:141–157PubMedCrossRef
2.
go back to reference Caulo M, Briganti C, Mattei PA, Perfetti B, Ferretti A, Romani GL, Tartaro A, Colosimo C (2007) New morphologic variants of the hand motor cortex as seen with MR imaging in a large study population. AJNR Am J Neuroradiol 28:1480–1485PubMedCrossRef Caulo M, Briganti C, Mattei PA, Perfetti B, Ferretti A, Romani GL, Tartaro A, Colosimo C (2007) New morphologic variants of the hand motor cortex as seen with MR imaging in a large study population. AJNR Am J Neuroradiol 28:1480–1485PubMedCrossRef
3.
go back to reference Gass A, Szabo K, Behrens S, Rossmanith C, Hennerici M (2001) A diffusion-weighted MRI study of acute ischemic distal arm paresis. Neurology 57:1589–1594PubMed Gass A, Szabo K, Behrens S, Rossmanith C, Hennerici M (2001) A diffusion-weighted MRI study of acute ischemic distal arm paresis. Neurology 57:1589–1594PubMed
4.
go back to reference Tei H (1999) Monoparesis of the right hand following a localised infarct in the left “precentral knob”. Neuroradiology 41:269–270PubMedCrossRef Tei H (1999) Monoparesis of the right hand following a localised infarct in the left “precentral knob”. Neuroradiology 41:269–270PubMedCrossRef
5.
go back to reference Phan TG, Evans BA, Huston J (2000) Pseudoulnar palsy from a small infarct of the precentral knob. Neurology 54:2185PubMed Phan TG, Evans BA, Huston J (2000) Pseudoulnar palsy from a small infarct of the precentral knob. Neurology 54:2185PubMed
6.
go back to reference Takahashi N, Kawamura M, Araki S (2002) Isolated hand palsy due to cortical infarction: localization of the motor hand area. Neurology 58:1412–1414PubMed Takahashi N, Kawamura M, Araki S (2002) Isolated hand palsy due to cortical infarction: localization of the motor hand area. Neurology 58:1412–1414PubMed
7.
go back to reference Newcommon NJ, Green TL, Haley E, Cooke T, Hill MD (2003) Improving the assessment of outcomes in stroke: use of a structured interview to assign grades on the modified Rankin Scale. Stroke 34:377–378PubMedCrossRef Newcommon NJ, Green TL, Haley E, Cooke T, Hill MD (2003) Improving the assessment of outcomes in stroke: use of a structured interview to assign grades on the modified Rankin Scale. Stroke 34:377–378PubMedCrossRef
8.
go back to reference Timsit SG, Sacco RL, Mohr JP, Foulkes MA, Tatemichi TK, Wolf PA, Price TR, Hier DB (1993) Brain infarction severity differs according to cardiac or arterial embolic source. Neurology 43:728–733PubMed Timsit SG, Sacco RL, Mohr JP, Foulkes MA, Tatemichi TK, Wolf PA, Price TR, Hier DB (1993) Brain infarction severity differs according to cardiac or arterial embolic source. Neurology 43:728–733PubMed
9.
go back to reference Lee PH, Oh SH, Bang OY, Joo SY, Joo IS, Huh K (2004) Infarct patterns in atherosclerotic middle cerebral artery versus internal carotid artery disease. Neurology 62:1291–1296PubMed Lee PH, Oh SH, Bang OY, Joo SY, Joo IS, Huh K (2004) Infarct patterns in atherosclerotic middle cerebral artery versus internal carotid artery disease. Neurology 62:1291–1296PubMed
10.
go back to reference Hedberg M, Boivie P, Edström C, Engström KG (2005) Cerebrovascular accidents after cardiac surgery: an analysis of CT scans in relation to clinical symptoms. Scand Cardiovasc J 39:299–305PubMedCrossRef Hedberg M, Boivie P, Edström C, Engström KG (2005) Cerebrovascular accidents after cardiac surgery: an analysis of CT scans in relation to clinical symptoms. Scand Cardiovasc J 39:299–305PubMedCrossRef
11.
go back to reference Yoo KM, Shin HK, Chang HM, Caplan LR (1998) Middle cerebral artery occlusive disease: the New England medical center stroke registry. J Stroke Cerebrovasc Dis 7:344–351PubMedCrossRef Yoo KM, Shin HK, Chang HM, Caplan LR (1998) Middle cerebral artery occlusive disease: the New England medical center stroke registry. J Stroke Cerebrovasc Dis 7:344–351PubMedCrossRef
12.
go back to reference Kumral E, Celebisoy M, Celebisoy N, Canbaz DH, Calli C (2007) Dysarthria due to supratentorial and infratentorial ischemic stroke: a diffusion-weighted imaging study. Cerebrovasc Dis 23:331–338PubMedCrossRef Kumral E, Celebisoy M, Celebisoy N, Canbaz DH, Calli C (2007) Dysarthria due to supratentorial and infratentorial ischemic stroke: a diffusion-weighted imaging study. Cerebrovasc Dis 23:331–338PubMedCrossRef
13.
go back to reference van der Zwan A, Hillen B (1991) Review of the variability of the territories of the major cerebral arteries. Stroke 22:1078–1084PubMed van der Zwan A, Hillen B (1991) Review of the variability of the territories of the major cerebral arteries. Stroke 22:1078–1084PubMed
14.
go back to reference van der Zwan A, Hillen B, Tulleken CA, Dujovny M (1993) A quantitative investigation of the variability of the major cerebral arterial territories. Stroke 24:1951–1959PubMed van der Zwan A, Hillen B, Tulleken CA, Dujovny M (1993) A quantitative investigation of the variability of the major cerebral arterial territories. Stroke 24:1951–1959PubMed
15.
go back to reference Hennerici M, Daffertshofer M, Jakobs L (1998) Failure to identify cerebral infarct mechanisms from topography of vascular territory lesions. AJNR Am J Neuroradiol 19:1067–1074PubMed Hennerici M, Daffertshofer M, Jakobs L (1998) Failure to identify cerebral infarct mechanisms from topography of vascular territory lesions. AJNR Am J Neuroradiol 19:1067–1074PubMed
16.
go back to reference Whisnant JP (1982) Multiple particles injected may all go to the same cerebral artery branch. Stroke 13:720PubMed Whisnant JP (1982) Multiple particles injected may all go to the same cerebral artery branch. Stroke 13:720PubMed
17.
go back to reference Ugur HC, Kahilogullari G, Coscarella E, Unlu A, Tekdemir I, Morcos JJ, Elhan A, Baskaya MK (2005) Arterial vascularization of primary motor cortex (precentral gyrus). Surg Neurol 64 Suppl 2:48–52CrossRef Ugur HC, Kahilogullari G, Coscarella E, Unlu A, Tekdemir I, Morcos JJ, Elhan A, Baskaya MK (2005) Arterial vascularization of primary motor cortex (precentral gyrus). Surg Neurol 64 Suppl 2:48–52CrossRef
18.
go back to reference Butefisch CM, Kleiser R, Korber B, Muller K, Wittsack HJ, Homberg V, Seitz RJ (2005) Recruitment of contralesional motor cortex in stroke patients with recovery of hand function. Neurology 64:1067–1069PubMed Butefisch CM, Kleiser R, Korber B, Muller K, Wittsack HJ, Homberg V, Seitz RJ (2005) Recruitment of contralesional motor cortex in stroke patients with recovery of hand function. Neurology 64:1067–1069PubMed
Metadata
Title
Ischemic stroke of the cortical “hand knob” area: stroke mechanisms and prognosis
Authors
Nils Peters
Stefanie Müller-Schunk
Tobias Freilinger
Marco Düring
Thomas Pfefferkorn
Martin Dichgans
Publication date
01-07-2009
Publisher
D. Steinkopff-Verlag
Published in
Journal of Neurology / Issue 7/2009
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-009-5104-8

Other articles of this Issue 7/2009

Journal of Neurology 7/2009 Go to the issue