Benedictine hand of 'central' origin

A 67-year-old man was admitted to emergency room to investigate a left hand weakness started on awakening. Anamnesis revealed only a mild hypertension currently treated with ACE-inhibitors. Antigravitary tests in upper limbs showed a ‘benedictine’ hand (figure 1A,B). Sensory examination was unremarkable although the patient complained of nocturnal paraesthesias in left hand. Brain CT scan was negative. Initial diagnosis was ischaemic stroke even if a proximal median nerve injury was mimicked. Nerve conduction study and electromyographic examination of left arm, performed the day after, showed only a ‘mild’ carpal tunnel syndrome. Brain MRI, obtained 2 days after the onset of symptoms, confirmed a lesion of the right precentral and postcentral gyri, compatible with acute ischaemia (figure 1C,D). The patient was discharged with antiplatelet therapy; hand weakness fully disappeared within 2 months. Ischaemic events mimicking peripheral nerve disorders have been rarely reported.1 Generally small hand muscles...
Source: Emergency Medicine Journal - Category: Emergency Medicine Authors: Tags: Workplace injury, Pain (neurology), Stroke, Hypertension, Radiology, Clinical diagnostic tests, Radiology (diagnostics), Ethics, Trauma Images in emergency medicine Source Type: research