Top

BMC Neurology

Published in:

Open Access 01-12-2015 | Case report

Pseudoperipheral palsy: a case of subcortical infarction imitating peripheral neuropathy

Authors: Mirza Jusufovic, Astrid Lygren, Anne Hege Aamodt, Bård Nedregaard, Emilia Kerty

Published in: BMC Neurology | Issue 1/2015

Abstract

Background

Vascular damage in the central hand knob area can mimic peripheral motor nerve deficits.

Case presentation

We describe the case of a woman presenting with apparent peripheral neuropathy. Brain magnetic resonance imaging and computed tomography angiography revealed an infarct in the precentral hand knob area, with significant stenosis in the right proximal middle cerebral artery trunk. Subsequent 3-Tesla magnetic resonance imaging of the brain suggested cerebral angiitis. The patient experienced improved hand function following combined glucocorticoid and cyclophosphamide treatment.

Conclusion

Vascular damage in the hand knob area should be considered when evaluating peripheral motor nerve deficits in the presence of normal nerve conduction velocities. The diagnosis of cerebral angiitis remains a major challenge for clinicians.

Chen PL, Hsu HY, Wang PY. Isolated hand weakness in cortical infarctions. J Formos Med Assoc. 2006;105(10):861–5.CrossRefPubMed

Phan TG, Evans BA, Huston J. Pseudoulnar palsy from a small infarct of the precentral knob. Neurology. 2000;54(11):2185.CrossRefPubMed

Kim JS. Predominant involvement of a particular group of fingers due to small, cortical infarction. Neurology. 2001;56(12):1677–82.CrossRefPubMed

Timsit S, Logak M, Manai R, Rancurel G. Evolving isolated hand palsy: a parietal lobe syndrome associated with carotid artery disease. Brain. 1997;120(Pt 12):2251–7.CrossRefPubMed

Lampl Y, Gilad R, Eshel Y, Sarova-Pinhas I. Strokes mimicking peripheral nerve lesions. Clin Neurol Neurosurg. 1995;97(3):203–7.CrossRefPubMed

Lee PH, Han SW, Heo JH. Isolated weakness of the fingers in cortical infarction. Neurology. 1998;50(3):823–4.CrossRefPubMed

Celebisoy M, Ozdemirkiran T, Tokucoglu F, Kaplangi DN, Arici S. Isolated hand palsy due to cortical infarction: localization of the motor hand area. Neurologist. 2007;13(6):376–9.CrossRefPubMed

Takahashi N, Kawamura M, Araki S. Isolated hand palsy due to cortical infarction: localization of the motor hand area. Neurology. 2002;58(9):1412–4.CrossRefPubMed

Kim SG, Ashe J, Georgopoulos AP, Merkle H, Ellermann JM, Menon RS, et al. Functional imaging of human motor cortex at high magnetic field. J Neurophysiol. 1993;69(1):297–302.PubMed

10.

Yousry TA, Schmid UD, Alkadhi H, Schmidt D, Peraud A, Buettner A, et al. Localization of the motor hand area to a knob on the precentral gyrus. A new landmark. Brain. 1997;120(Pt 1):141–57.CrossRefPubMed

11.

Yousry TA, Schmid UD, Jassoy AG, Schmidt D, Eisner WE, Reulen HJ, et al. Topography of the cortical motor hand area: prospective study with functional MR imaging and direct motor mapping at surgery. Radiology. 1995;195(1):23–9.CrossRefPubMed

12.

Peters N, Muller-Schunk S, Freilinger T, During M, Pfefferkorn T, Dichgans M. Ischemic stroke of the cortical “hand knob” area: stroke mechanisms and prognosis. J Neurol. 2009;256(7):1146–51.CrossRefPubMed

13.

Birnbaum J, Hellmann DB. Primary angiitis of the central nervous system. Arch Neurol. 2009;66(6):704–9.CrossRefPubMed

14.

Salvarani C, Brown Jr RD, Hunder GG. Adult primary central nervous system vasculitis. Lancet. 2012;380(9843):767–77.CrossRefPubMed

15.

Mandell DM, Matouk CC, Farb RI, Krings T, Agid R, terBrugge K, et al. Vessel wall MRI to differentiate between reversible cerebral vasoconstriction syndrome and central nervous system vasculitis: preliminary results. Stroke. 2012;43(3):860–2.CrossRefPubMed

16.

Obusez EC, Hui F, Hajj-Ali RA, Cerejo R, Calabrese LH, Hammad T, et al. High-resolution MRI vessel wall imaging: spatial and temporal patterns of reversible cerebral vasoconstriction syndrome and central nervous system vasculitis. AJNR Am J Neuroradiol. 2014;35(8):1527–32.CrossRefPubMed

17.

Swartz RH, Bhuta SS, Farb RI, Agid R, Willinsky RA, Terbrugge KG, et al. Intracranial arterial wall imaging using high-resolution 3-tesla contrast-enhanced MRI. Neurology. 2009;72(7):627–34.CrossRefPubMed

18.

Butefisch CM, Kleiser R, Korber B, Muller K, Wittsack HJ, Homberg V, et al. Recruitment of contralesional motor cortex in stroke patients with recovery of hand function. Neurology. 2005;64(6):1067–9.CrossRefPubMed

Title: Pseudoperipheral palsy: a case of subcortical infarction imitating peripheral neuropathy
Authors: Mirza Jusufovic
Astrid Lygren
Anne Hege Aamodt
Bård Nedregaard
Emilia Kerty
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: BMC Neurology / Issue 1/2015
Electronic ISSN: 1471-2377
DOI: https://doi.org/10.1186/s12883-015-0409-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Pseudoperipheral palsy: a case of subcortical infarction imitating peripheral neuropathy

Abstract

Background

Case presentation

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Case presentation

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2015

Multicentric Castleman’s disease with voltage-gated potassium channel antibody-positive limbic encephalitis: a case report

Bent spine syndrome as an initial manifestation of late-onset multiple acyl-CoA dehydrogenase deficiency: a case report and literature review

T1- vs. T2-based MRI measures of spinal cord volume in healthy subjects and patients with multiple sclerosis

Neuropathological comparisons of amnestic and nonamnestic mild cognitive impairment

Acute fatal posthypoxic leukoencephalopathy following benzodiazepine overdose: a case report and review of the literature

Impact of sex in stroke thrombolysis: a coarsened exact matching study