Ischemic stroke of the "hand knob area": A case series and literature review. (July 2019)

• Record Type: Journal Article
• Authors: Finkelsteyn, Ana Mariel; Saucedo, Miguel Angel; Miquelini, L. Ariel; Chertcoff, Anibal; Bandeo, Lucrecia; Pacha, Sol; León Cejas, Luciana; Uribe Roca, Claudia; Fernández Pardal, Manuel; Reisin, Ricardo; Bonardo, Pablo
• Is Part Of: Journal of clinical neuroscience. Volume 65(2019)
• Page Start: 100
• Page End: 105
• Publication Date: 2019-07
• Subjects: Stroke -- Cortical infarction -- Hand knob -- Monoparesis -- Hand motor cortex infarction -- Isolated hand paresis; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2019.03.025
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Stroke in the "hand knob area" is frequently misdiagnosed and confused with a peripheral pathology. The prognosis will always depend on the involved stroke mechanism and the appropriate secondary prevention treatment. The most prevalent stroke mechanism was cryptogenic, mainly embolic stroke of undetermined source. The outcome was excellent regardless of stroke mechanism. Abstract: Isolated hand paresis may reflect an infarction of the "hand knob area", which represents less than 1% of all ischemic strokes. In this type of stroke, a potential source of embolism is often identified. There are no large case series regarding this topic in Latin America. Herein we present the largest cohort of this entity in the region and we compare our results with those previously published. We analyzed all stroke patients admitted to our hospital between May 2015 – June 2018. Only patients with motor +/− sensory deficits restricted to the hand and ischemic stroke confirmed by MRI were included. We assessed stroke mechanism, clinical characteristics and outcome. From 339 patients admitted with ischemic stroke, 12 (3.53%) were included (9 men, 75%). Mean age: 60.4 years-old (range:24–79). Localization of stroke: 8 patients (66%) precentral gyrus, 3 (25%) postcentral; in 1 both gyri were affected. Stroke mechanism according to TOAST classification was as follows: two patients (16%) large artery atherosclerosis, two cardioembolic, one other determined etiology (thrombophilia), seven (58%) undetermined etiology (SUE). Nine patients (75%) received antiplatelets and statins, and three (25%) anticoagulants. The mean follow-up period was 11 months (range 1–26). Stroke recurrence was observed in one patient. At follow up, eight patients (66%) had a modified Rankin Score (mRS) of 0 and one a mRS of 1. In conclusion, in this series the most prevalent stroke mechanism was SUE, mainly embolic stroke of undetermined source. The outcome was excellent regardless of stroke mechanism.