Pseudoradial Nerve Palsy Caused by Acute Ischemic Stroke

Abstract

Pseudoperipheral palsy has been used to characterize isolated monoparesis secondary to stroke. Isolated hand nerve palsy is a rare presentation for acute cerebral stroke. Our patient presented with clinical features of typical peripheral radial nerve palsy and a normal computed tomography scan of the head, which, without a detailed history and neurological examination, could have been easily misdiagnosed as a peripheral nerve lesion deferring further investigation for a stroke. We stress the importance of including cerebral infarction as a critical differential diagnosis in patients presenting with sensory-motor deficit in an isolated peripheral nerve pattern. A good history and physical exam can differentiate stroke from peripheral neuropathy as the cause of radial nerve palsy.

Lesion Pattern, Mechanisms, and Long-Term Prognosis in Patients with Monoparetic Stroke: A Comparison with Nonmonoparetic Stroke

“…In addition, not a few studies focused on anatomical location and functional topography of the hand motor area [ 14 – 17 ]. Even so, this rare stroke manifestation is important in real-world clinical practice because of its potential for misdiagnosis as peripheral neuropathy as shown in previous reports [ 7 – 10 ]. Moreover, two-thirds of our monoparetic stroke patients had no upper motor neuron sign.…”

“…Thus, to date, there has been little stroke data involving monoparesis of the arm or leg, irrespective of sensory changes seen in a consecutive stroke cohort. However, the rare symptomatic presentation has its clinical implications among various stroke manifestations in that it has a confusing feature possibly leading to misdiagnosis as a peripheral neuropathy as shown in many case series [ 7 – 10 ]. Moreover, there has been little data about its prognosis including stroke recurrence.…”

“Cortical” Wrist Drop due to a Cerebral Peduncle Infarct

“…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].…”

“…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.…”

Synkinetic wrist extension in distinguishing cortical hand from radial nerve palsy

“…Acute ischaemic stroke should be considered in the differential diagnosis of sudden onset of motor deficit in an isolated peripheral nerve pattern, particularly if there is no pain or sensory loss 2. In pseudoradial nerve palsy due to brain lesions, preserved synkinetic wrist extension following fist closure is a useful clue to the right diagnosis.…”