Cortical Hand Knob Stroke: A Case Report of Isolated Hand Weakness and Recovery

Cortical hand knob stroke is a rare form of stroke that affects the motor cortex responsible for controlling fine hand movements. This condition, most commonly caused by ischemia in the "hand knob" region of the precentral gyrus, can present with isolated hand weakness, often mimicking peripheral neuropathies and leading to diagnostic delays. We report a case of a 65-year-old right-handed woman who experienced a sudden onset of left-hand weakness, along with resolving slurred speech and facial droop, while she was working at her office. Due to her persistent left-hand weakness, magnetic resonance imaging of the brain was performed. This revealed a focal ischemic lesion in the right precentral gyrus, specifically involving the cortical hand knob region. The patient was treated with antiplatelet therapy, high-dose statins, and lifestyle modifications, including smoking cessation. Over five months, she showed significant recovery of hand strength. This case highlights the diagnostic challenge posed by cortical hand knob stroke, which is often misinterpreted as peripheral neuropathy, leading to delays in appropriate treatment. Recognizing this rare stroke subtype is essential for timely management and improved patient outcomes.