Cortical Hand Knob Stroke: Report of 25 Cases

Orosz, P.; Szôcs, Ildikó; Rudas, Gábor; Folyovich, András; Bereczki, Dániel; Vastagh, Ildikó

doi:10.1016/j.jstrokecerebrovasdis.2018.02.045

Cited by 26 publications

(24 citation statements)

References 16 publications

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“…In another case series of 25 patients, the authors emphasized the fact that an ischemic stroke of the hand knob area may mimic peripheral nerve damage as the weakness may involve the lateral radial fingers, medial ulnar fingers, or asymmetric weakness of both. Again, an embolic etiology was emphasized and the natural history was mostly benign; 36% of the patients had greater than 50% stenosis of the ipsilateral internal carotid artery and 12% had atrial fibrillation [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Ischemic Infarct of the Hand Knob Gyrus: Natural History, Morphology, and Localizing Value of the Omega Sulcus – A Case Report With a Side Note on the Dynamic Forces Underlying Sulci Formation

Kesserwani¹

2020

Cureus

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We describe a case of right-hand weakness localizable to an ischemic infarct of the hand knob gyrus of the left primary motor cortex. The hand knob gyrus is usually delimited by an omega-shaped sulcus, which is useful in outlining the posterior border of the frontal lobe. Being a cortical infarct, a potential embolic etiology was investigated and found, in keeping with previous case series reports. This finding, along with the relatively benign nature of this type of ischemic infarction, is emphasized. Identifying the omega sulcus is important as it is a reliable landmark demarcating eloquent motor cortex, which is critically important in planning surgical removal of brain tumors. In this case report, we review the largest case series of ischemic infarcts of the hand knob gyrus. We also describe the morphology of the omega sulcus, discuss the various theories underlying the convolutions or folding of the gyri of mammalian and human brains, and speculate as to why ischemic infarcts of the hand knob gyrus carry a relatively benign outcome.

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Section: Discussionmentioning

confidence: 99%

Ischemic Infarct of the Hand Knob Gyrus: Natural History, Morphology, and Localizing Value of the Omega Sulcus – A Case Report With a Side Note on the Dynamic Forces Underlying Sulci Formation

Kesserwani¹

2020

Cureus

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“…A VIII. kerület fiatalabb korcsoportjai köré ben magasabb a rizikóbetegségek prevalenciája, ami korábbi kis esetszámú klinikai vizs gá la taink ban is szembetûnô volt 9,10,37,38 . Vélhetôen ezzel összefüggésben nemcsak az akut halálozás magasabb a VIII.…”

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A szocioökonómiai helyzet és a stroke kapcsolata a fővárosban

et al. 2020

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Background and purpose-The well-known gap between stroke mortality of Eastern and Western Euro pean countries may reflect the effect of socioeconomic differences. Such a gap may be present between neighborhoods of different wealth within one city. We set forth to compare age distribution, incidence, case fatality, mortality, and risk factor profile of stroke patients of the poorest (District 8) and wealthiest (District 12) districts of Budapest. Methods-We synthesize the results of our former comparative epidemiological investigations focusing on the association of socioeconomic background and features of stroke in two districts of the capital city of Hungary. Results-The "Budapest District 8-12 project" pointed out the younger age of stroke patients of the poorer district, and established that the prevalence of smoking, alcoholconsumption, and untreated hypertension is also higher in District 8. The "Six Years in Two Districts" project involving 4779 patients with a 10-year follow-up revealed higher incidence, case fatality and mortality of stroke in the less wealthy district. The younger patients of the poorer region show higher risk-factor prevalence, die younger and their fatality grows faster during long-term follow-up. Conclusion-The higher prevalence of risk factors and the higher fatality of the younger age groups in the socioeconomically deprived district reflect the higher vulnerability of the population in District 8. The missing link between poverty and stroke outcome seems to be lifestyle risk-factors and lack of adherence to primary preventive efforts. Public health campaigns on stroke prevention should focus on the young generation of socioeconomically deprived neighborhoods.

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“…In a 5-year study in Norway, out of 866 patients with acute ischemic stroke 6 (0.7%) had a single lesion in the hand knob region [ 4 ]. In our study of 25 cases over 10 years we estimated the rate of hand knob strokes to be 0.35% [ 5 ]. Although the hand knob area certainly may be affected by intracerebral tumors like glioblastoma (see Fig.…”

Section: Introductionmentioning

confidence: 99%

A case report of isolated distal upper extremity weakness due to cerebral metastasis involving the hand knob area

et al. 2018

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BackgroundUnilateral weakness of an upper extremity is most frequently caused by traumatic nerve injury or compression neuropathy. In rare cases, lesion of the central nervous system may result in syndromes suggesting peripheral nerve damage by the initial examination. Pseudoperipheral hand palsy is the best known of these, most frequently caused by a small lesion in the contralateral motor cortex of the brain. The ‘hand knob’ area refers to a circumscribed region in the precentral gyrus of the posterior frontal lobe, the lesion of which leads to isolated weakness of the upper extremity mimicking peripheral nerve damage. The etiology of this rare syndrome is almost exclusively related to an embolic infarction.Case presentationWe present the case of a 70-year-old male patient with isolated left sided upper extremity weakness and clumsiness without sensory disturbance suggesting a lesion of the radial nerve. Nerve conduction studies had normal results excluding peripheral nerve damage. Neuroimaging (cranial CT and MRI) detected 3 space occupying lesions, one of them in the right precentral gyrus. An irregularly shaped tumor was found by CT in the left lung with multiple associated lymph node conglomerates. The metastasis from this mucinous tubular adenocarcinoma with solid anaplastic parts to the ‘hand knob’ area was responsible for the first clinical sign related to the pulmonary malignancy.ConclusionsPseudoperipheral palsy of the upper extremity is not necessarily the consequence of an embolic stroke. If nerve conduction studies have normal results, neuroimaging – preferably MRI – should be performed, as lesion in the hand-knob area of the precentral gyrus can also be caused by a malignancy.

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Cortical Hand Knob Stroke: Report of 25 Cases

Cited by 26 publications

References 16 publications

Ischemic Infarct of the Hand Knob Gyrus: Natural History, Morphology, and Localizing Value of the Omega Sulcus – A Case Report With a Side Note on the Dynamic Forces Underlying Sulci Formation

Ischemic Infarct of the Hand Knob Gyrus: Natural History, Morphology, and Localizing Value of the Omega Sulcus – A Case Report With a Side Note on the Dynamic Forces Underlying Sulci Formation

A szocioökonómiai helyzet és a stroke kapcsolata a fővárosban

A case report of isolated distal upper extremity weakness due to cerebral metastasis involving the hand knob area

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