Acute ischemic stroke resembling Saturday night palsy

Pedroso, José Luiz; Knobel, Marcos; Massaud, Rodrigo Meirelles; Knobel, E

doi:10.1590/0004-282x20140025

Cited by 2 publications

(3 citation statements)

References 4 publications

(2 reference statements)

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“…Centrally, the motor area controlling hand and wrist movements lies in the lateral side of the contralateral cerebral cortex in the motor homunculus. Lesions in this "hand knob" area of the motor strip would result in an inability to centrally initiate an extension movement of the contralateral wrist and fingers, resulting in a cortical wrist drop [1][2][3][4][5][6][7][8][9][10]. Interestingly, a patient with a cortical wrist drop due to posterior borderzone infarction has been reported [11].…”

Section: Discussionmentioning

confidence: 99%

“…However, lesions in the contralateral cerebral motor cortex responsible for wrist movements are being increasingly recognized as the cause of a central or "cortical" wrist drop. The underlying disease may be due to contusion [1], tumour [2], or stroke [3][4][5][6][7][8]. We report a unique case of "cortical" wrist drop due to an acute infarction not of the contralateral cerebral cortex, but rather of the contralateral cerebral peduncle, and explain the anatomical basis for its occurrence.…”

Section: Introductionmentioning

confidence: 87%

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“Cortical” Wrist Drop due to a Cerebral Peduncle Infarct

2020

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Wrist drops are usually due to a peripheral neuropathy affecting the radial nerve. Cortical wrist drops may occur, usually due to a lesion in the contralateral hand area of the motor cortex. We report a unique case of “cortical” wrist drop due to an acute infarction of the contralateral cerebral peduncle. The patient is a 70-year-old gentleman with the vascular factors of hypertension, hyperlipidaemia, and prior cerebellar strokes, who developed sudden onset of right wrist weakness without numbness. Neurological examination showed a right wrist and finger drop. Nerve conduction study of the radial nerve was normal. MRI brain revealed an acute infarct in the medial part of the left cerebral peduncle, extending slightly to the medial thalamus; there were also old medial posterior cerebellar infarcts. Time of flight MR angiography was normal, with hypoplastic right vertebral artery. Echocardiography was normal but for a dilated right atrium. Electrocardiogram was normal, and 24-hour Holter monitoring detected infrequent atrial and ventricular ectopics. X-ray wrist showed an old ulnar styloid fracture. Nerve conduction study of the radial nerve was normal. He was switched from aspirin to clopidogrel and underwent rehabilitation. The cerebral peduncle should not be forgotten when attempting to anatomically localise the site of the lesion when evaluating a patient with a wrist drop.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 87%

“Cortical” Wrist Drop due to a Cerebral Peduncle Infarct

2020

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“…Stroke chameleons encompass an atypical group of syndromes that do not initially appear to be cerebrovascular accidents; however, they are found to be acute strokes after further analysis [ 1 , 2 , 3 , 4 , 5 ]. Less than 1% of strokes manifest clinically as a radial neuropathy.…”

Section: Introductionmentioning

confidence: 99%

Stroke Chameleons Manifesting as Distinct Radial Neuropathies: Expertise Can Hasten the Diagnosis

et al. 2017

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Objective: Stroke chameleons encompass an atypical group of syndromes that do not initially appear to be cerebrovascular accidents. The objective of this study was to report patients with different lesions of central origin clinically presenting as wrist drop and with a semiology similar to that produced by peripheral lesions of the radial nerve at different topographical levels. Methods: This is a case series study of patients presenting with wrist drop during the acute phase of stroke who were assessed by clinical examination and CT and MRI brain scans. Results: Three cases presenting as monoparesis were evaluated. In all patients, the MRI revealed restricted diffusion in the pre- and post-central gyrus. Electromyography showed that the functionality of the radial, median, and ulnar nerves were intact in all three cases. The monoparesis resolved completely within 1 month of rehabilitation therapy, and no evidence of recurrent or new events was reported during the 6-month follow-up after stenting. Conclusion: The central message of this study is that when acute onset symptoms are present in a relatively old patient with vascular risk factors, stroke should be considered as the possible aetiology until proven otherwise, and the appropriate steps should be taken to avoid a delay in the treatment and to improve outcomes.

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Acute ischemic stroke resembling Saturday night palsy

Cited by 2 publications

References 4 publications

“Cortical” Wrist Drop due to a Cerebral Peduncle Infarct

“Cortical” Wrist Drop due to a Cerebral Peduncle Infarct

Stroke Chameleons Manifesting as Distinct Radial Neuropathies: Expertise Can Hasten the Diagnosis

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