Jain Moli, Harjpal Pallavi, Kovela Rakesh K, Vardhan Vishnu
Department of Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences, Wardha, IND.
Department of Physiotherapy, Nitte Institute of Physiotherapy, Nitte (Deemed to be University), Mangalore, IND.
Cureus. 2022 Oct 1;14(10):e29819. doi: 10.7759/cureus.29819. eCollection 2022 Oct.
Traumatic nerve damage or compression neuropathy is the most common cause of unilateral weakness in an upper extremity. Rarely, a central nervous system lesion may cause syndromes that initially appear to indicate peripheral nerve injury. The most well known of these is pseudoperipheral hand palsy, which is typically brought on by a minor brain lesion in the contralateral motor cortex. The term "hand knob" refers to a restricted area in the posterior frontal lobe's precentral gyrus, a lesion that causes isolated weakness in the upper extremity that mimics injury to peripheral nerves. The majority of the time, an embolic infarction is the cause of this uncommon condition. We present a case of a 52-year-old female who presented to the medicine outpatient department with sudden onset of acute pure motor paresis of the right hand. She also complained of clumsiness in her hand and several episodes of generalized headache in the parieto-occipital region in the past two weeks. Following an initial evaluation by a physician, she was advised for MRI of the head and neck, which reported occlusion in the petrous part of the left internal carotid artery, and referred to physiotherapy for further management. She was assessed and a task-specific training protocol was made for the patient, which also included physiotherapy techniques like grip exercises, mirror therapy, and strengthening. There was an improvement in the patient within a few weeks that was evident with the outcome measures post-rehabilitation. This case study is really a good case not only in regards to peculiarities and clinical presentation but also in promoting rarely implementation of rehabilitation to get patients back to their previous functional status.
创伤性神经损伤或压迫性神经病变是上肢单侧无力最常见的原因。很少有中枢神经系统病变会导致最初看似提示周围神经损伤的综合征。其中最广为人知的是假性周围性手部麻痹，通常由对侧运动皮层的轻微脑损伤引起。“手部旋钮”一词指的是额叶后部中央前回的一个受限区域，该病变会导致上肢孤立性无力，类似于周围神经损伤。大多数情况下，栓塞性梗死是这种罕见病症的病因。我们报告了一例52岁女性，她因右手突然出现急性纯运动性麻痹而到内科门诊就诊。她还抱怨手部笨拙，并且在过去两周内有几次顶枕部的全身性头痛发作。在医生进行初步评估后，建议她进行头颈部MRI检查，结果报告左颈内动脉岩部闭塞，并转诊至物理治疗科进行进一步治疗。对她进行了评估，并为患者制定了特定任务的训练方案，其中还包括抓握练习、镜像疗法和强化训练等物理治疗技术。几周内患者病情有所改善，康复后的结果指标显示效果明显。这个病例研究不仅在特殊性和临床表现方面是一个很好的案例，而且在促进很少实施的康复治疗以使患者恢复到以前的功能状态方面也是一个很好的案例。
