Turkish Journal of Geriatrics 2015 , Vol 18, Issue 3
Gülcan ÖZTÜRK1, Feyza ÜNLÜ ÖZKAN2, Eren GÖZKE3, İlknur AKTAŞ2, Serap URGAN GÜNEŞ4
1Gebze Fatih State Hospital, Physical Medicine and Rehabilitation Clinic, KOCAELİ
2Fatih Sultan Mehmet Training and Research Hospital, Physical Medicine and Rehabilitation Clinic, İSTANBUL
3Fatih Sultan Mehmet Training and Research Hospital, Neurology Clinic, İSTANBUL
4Gebze Fatih State Hospital, Radiology Clinic, KOCAELİ
Isolated pure motor weakness of a hand or particular group of fingers usually results from a peripheral neurological disease, although, rarely, it can be caused by central neurological disease, such as cortical infarcts. Weakness of a hand or a particular group of fingers due to cortical cerebral infarction has been described as “pseudo-peripheral palsy.” The motor representation of the hand in the brain is localized to a knob-like structure in the precentral gyrus. A lesion localized in a region of the hand knob could affect all the muscles of the hand or the muscles innervated by the radial, median, and ulnar nerves. Infarctions in the parietal lobe or white matter of the angular gyrus, postcentral gyrus, ventroposterior thalamus, corona radiate, basal ganglia, and posterior limb of the internal capsule can also mimic peripheral nerve lesions. In patients with monoparesis caused by stroke, cerebral computed tomography can miss infarct lesions. Using magnetic resonance imaging can allow the identification of small vascular lesions that cause monoparesis. Early diagnosis of “pseudo-peripheral palsy” is important for adopting a suitable therapeutic approach to prevent a recurrent or larger cortical infarction. We describe 65-year-old patient who presented with an acute paresis of her left hand, suggesting a peripheral nerve lesion. However, on clinical examination, a peripheral origin could not be veri?ed, prompting further investigation. Di?usion-weighted magnetic resonance imaging revealed an acute hemorrhagic lesion. The peripheral nerve pattern of lesions caused by cortical infarcts should be taken into consideration in the differential diagnosis of isolated hand monoparesis. Keywords : Aged; Monoparesis; Hand