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Isolated hand weakness in cortical infarctions.

Po-Lin Chen1, Hung-Yi Hsu, Pao-Yu Wang

  • 1Division of Neurology, Department of Internal Medicine, Taichung Veterans General Hospital, 160 Section 3 Taichung-Kang Road, Taichung 407, Taiwan.

Journal of the Formosan Medical Association = Taiwan Yi Zhi
|September 27, 2006
PubMed
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Stroke-related isolated hand weakness is rare and can be misdiagnosed. This study found that cerebral infarctions affecting areas beyond the primary motor cortex (M1) hand knob can cause hand weakness.

Area of Science:

  • Neurology
  • Neuroscience
  • Radiology

Background:

  • Isolated hand weakness following a stroke is uncommon and frequently misdiagnosed as peripheral nerve issues.
  • Understanding the neuroanatomical basis of this presentation is crucial for accurate diagnosis and treatment.

Purpose of the Study:

  • To investigate the clinical and radiological characteristics of patients presenting with isolated hand weakness due to stroke.
  • To identify the specific brain regions involved in causing isolated hand weakness.

Main Methods:

  • A cohort of six patients (five men, one woman) with isolated hand weakness was studied.
  • Cranial magnetic resonance imaging (MRI) was performed to confirm stroke diagnosis and localize lesions.
  • Clinical assessment documented the pattern of hand weakness (uniform, radial, or ulnar).

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Main Results:

  • Cranial MRI revealed acute infarctions in the hand knob area of the primary motor cortex (M1) in five patients.
  • One patient had an infarction in the postcentral gyrus (sensory cortex) sparing the precentral gyrus (motor cortex).
  • Two patients with uniform digit weakness also showed involvement of the inferior parietal lobule.

Conclusions:

  • Isolated hand weakness from cerebral infarction is not exclusively linked to lesions in the M1 hand knob area.
  • The neural control of hand movement involves a network extending beyond the M1 hand knob, including sensory and parietal regions.
  • These findings challenge the traditional view and highlight the complexity of motor control representation in the brain.