'Cortical Hand' in the Emergency Department: Two Case Reports

Area of Science:

• Neurology
• Stroke Medicine
• Neuroimaging

Background:

• Cortical hand strokes impact the motor cortex's 'hand knob' area.
• These strokes lead to isolated weakness in the distal upper limb or hand.
• They are infrequent and often misdiagnosed as peripheral nerve lesions.

Observation:

• Two cases of sudden-onset hand weakness are presented.
• Neurological examination and MRI confirmed upper motor neuron lesions.
• One case involved transient ischemic attack (TIA) leading to cortical hand stroke.

Findings:

• Cortical hand strokes present as isolated distal upper limb or hand weakness.
• Misdiagnosis as peripheral lesions is common due to subtle presentation.
• These strokes are frequently initial events and can be embolic.

Implications:

• Emergency physicians must consider cortical hand strokes in cases of wrist drop.
• Accurate diagnosis is vital for initiating secondary stroke prevention strategies.
• Awareness can improve patient outcomes by facilitating timely and appropriate management.