Zahir Hussain Sharafath Hussain, Elizabeth Vincent Maria, John Emil Tom, Ihsan Fatima
Internal Medicine, Milton Keynes University Hospital, Milton Keynes, GBR.
Cureus. 2024 Nov 17;16(11):e73840. doi: 10.7759/cureus.73840. eCollection 2024 Nov.
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.
皮质手部运动区卒中是一种罕见的卒中形式，它会影响负责控制手部精细运动的运动皮质。这种情况最常见的原因是中央前回“手部运动区”区域的缺血，可能表现为单纯的手部无力，常常类似周围神经病变，导致诊断延误。我们报告一例65岁右利手女性病例，她在办公室工作时突然出现左手无力，同时言语不清和面部下垂症状逐渐缓解。由于她的左手持续无力，进行了脑部磁共振成像检查。结果显示右侧中央前回有一个局灶性缺血性病变，具体累及皮质手部运动区。该患者接受了抗血小板治疗、大剂量他汀类药物治疗以及包括戒烟在内的生活方式改变。五个多月来，她的手部力量有了显著恢复。这个病例凸显了皮质手部运动区卒中带来的诊断挑战，它常常被误诊为周围神经病变，导致适当治疗的延误。认识到这种罕见的卒中亚型对于及时治疗和改善患者预后至关重要。
