[Isolated monoparesis of hand or foot caused by cortical ischaemic stroke]

A 78-year-old man presented with painless weakness of his right thumb and index finger. Neurological examination confirmed weakness of the intrinsic musculature of the hand without sensory impairments. Diffusion-weighted imaging (DWI) showed ischaemia of the left cortical hand knob. A 71-year-old man presented with isolated paralysis of plantar flexors and dorsiflexors of the right ankle upon awakening. DWI confirmed a cortical ischaemic cause of the symptoms. Acute isolated hand or foot paresis is a rare symptom of stroke. Early diagnosis is challenging because presentation may simulate a peripheral origin. If the distribution of the intrinsic hand or foot muscle weakness is beyond the territory of a single peripheral nerve or if increased tendon reflexes are present, cortical ischaemia should be considered. DWI is essential for early diagnosis of cortical ischaemia. Rapid initiation of secondary prevention can reduce the risk of stroke recurrence.