Thalamic stroke resulting in rheumatoid appearances in the hand

The patient, a 72-year-old woman, presented with joint deformities for 3 years. She did not notice any joint pain or swelling, but the fingers of the left hand as well as the toes of the left foot gradually became deformed, with all the joints on the right side totally spared. The fingers of the left hand exhibited a swan-neck deformity, and the left thumb demonstrated a thumb-in-palm deformity (Fig. 1A). In her past medical history, she experienced a right thalamic infarct 4 years ago, 1 year before the occurrence of joint deformity (Fig. 1B). She denied any paraesthesia or obvious weakness of the left extremities. The laboratory examinations revealed negative RF, anti-CCP antibody, and normal ESR and CRP. X-ray of the left hand showed deformities without articular destruction. She was diagnosed as having thalamic hand and was transferred to a rehabilitation department for further management. In this case, first sight of the swan-neck deformity led to the impression of possible RA, but the unilateral pattern of joint involvement as well as the laboratory and imaging results ruled out rheumatic diseases. Fig. 1Asymmetrical swan-neck deformity resulting from thalamic stroke(A) Typical swan-neck deformity of the left hand, with the right hand unaffected; (B) CT scan demonstrating thalamic infarct.
Source: Rheumatology - Category: Rheumatology Source Type: research