Archives of Medicine and Health Sciences

TEACHING IMAGES
Year
: 2014  |  Volume : 2  |  Issue : 1  |  Page : 111--112

Pseudoperipheral palsy: A rare stroke "chameleon" due to cortical "hand knob" infarction


Shiga C. Rappai1, Prakash Harishchandra1, Bhaskara P. Shelley2,  
1 Department of Medicine, Yenepoya Medical College, Yenepoya University, Mangalore, Karnataka, India
2 Department of Neurology, Yenepoya Medical College, Yenepoya University, Mangalore, Karnataka, India

Correspondence Address:
Bhaskara P. Shelley
Department of Neurology, Yenepoya Medical College, Yenepoya University, Mangalore - 575 018, Karnataka
India




How to cite this article:
Rappai SC, Harishchandra P, Shelley BP. Pseudoperipheral palsy: A rare stroke "chameleon" due to cortical "hand knob" infarction.Arch Med Health Sci 2014;2:111-112


How to cite this URL:
Rappai SC, Harishchandra P, Shelley BP. Pseudoperipheral palsy: A rare stroke "chameleon" due to cortical "hand knob" infarction. Arch Med Health Sci [serial online] 2014 [cited 2020 Dec 1 ];2:111-112
Available from: https://www.amhsjournal.org/text.asp?2014/2/1/111/133851


Full Text

 Case Report



A 60-year-old lady with hypertension and dyslipidemia developed acute onset of isolated pure motor flaccid fractional weakness of the left distal hand while waking up in the morning after an uneventful night's sleep. For the last 2 months, she developed a new onset right-side locked vascular headache accompanied by intermittent visual obscuation in her right eye, right-sided scalp allodynia, and scored four on the Wong-Baker faces rating scale and 8 out of 10 in the numerical pain rating scale. Neurologic abnormalities revealed partial differential median nerve greater than radial nerve involvement [Figure 1]. The right superifical temporal artery was tender with decreased pulsations. Her nerve conduction study was normal, erythrocyte sedimentation rate (ESR) was 40 mm/1 st hour, elevated C-reactive protein with a thrombocytosis of 8 lakh cells/mm 3 . Temporal artery biopsy revealed histopathological evidence of treated temporal arteritis. Neuroimaging showed acute infarct in right precentral gyrus with selective involvement of the hand motor cortex. [1] She was started on 1 mg/kg/day of prednisolone and triple therapy. During follow-ups, she had made almost complete recovery of her pseudoperipheral weakness. [2] {Figure 1}

Even though the diagnosis of stroke is often straightforward, this case does pose the initial question "Is this a CNS event?" To separate the "pearl from the oyster," this case demonstrates clinical "pattern recognition" skills to differentiate stroke "mimics" from stroke "chameleons." This report illustrates the association of giant cell arteritis as the etiology of pseudoperipheral weakness, and reiterates the urgent need for early diagnosis of stroke especially so when selective hand motor cortex infacrtion is documented to be 1% of all ischemic strokes.

 Acknowledgment



Informed patient consent was obtained for publication of the case details and [Figure 1].

References

1Celebisoy M, Ozdemirkiran T, Tokucoglu F, Kaplangi DN, Arici S. Isolated hand palsy due to cortical infarction: Localization of the motor hand area. Neurologist 2007; 13:376-9.
2Pikula A, Stefanidou M, Romero JR, Kase CS. Pure motor upper limb weakness and infarction in the precentral gyrus: Mechanisms of stroke. J Vasc Interv Neurol 2011; 4:10-3.