A 90-year-old man woke-up with dropped hand. Examination showed weakness in left hand: inability to extend wrist and fingers. National Institutes of Health Stroke Scale (NIHSS): zero. He had left ventricular hypokinesia. Radial neuropathy was suspected. Considering age and risk for embolism, brain MRI was performed, and disclosed minor acute ischemic stroke in left frontal cortex (Figure).
. Patient with dropped hand and inability to extend left wrist, thumb and fingers (A). Diffusion-weighted brain MRI showing a small area of restricted diffusion in the left frontal cortex (B). ADC map-weighted brain MRI disclosing an hypointense signal in left frontal cortex supporting the diagnosis of acute ischemic stroke (C).
Upper extremities monoparesis rarely occur in cerebral cortex lesions, and may mimic peripheral nerve injuries11. Edlow JA, Selim MH. Atypical presentations of acute cerebrovascular syndromes. Lancet Neurol 2011;10:550-560.,22. Takahashi N, Kawamura M, Araki S. Isolated hand palsy due to cortical infarction: localization of the motor hand area. Neurology 2002;58:1412-1414.. Saturday night palsy is a colloquial term which describes radial nerve injuries from falling asleep with the arm under the body33. Spinner RJ, Poliakoff MB, Tiel RL. The origin of "Saturday night palsy"? Neurosurgery 2002;51:737-741.. Neurologists should be aware that cerebral cortex lesions in old patients with cardiovascular risk factors may present with motor paralysis limited to the upper extremities.
References
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1Edlow JA, Selim MH. Atypical presentations of acute cerebrovascular syndromes. Lancet Neurol 2011;10:550-560.
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2Takahashi N, Kawamura M, Araki S. Isolated hand palsy due to cortical infarction: localization of the motor hand area. Neurology 2002;58:1412-1414.
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3Spinner RJ, Poliakoff MB, Tiel RL. The origin of "Saturday night palsy"? Neurosurgery 2002;51:737-741.
Publication Dates
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Publication in this collection
May 2014
History
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Received
04 July 2013 -
Reviewed
20 Dec 2013 -
Accepted
13 Jan 2014
