Ischemic stroke of the “hand knob area”: A case series and literature review

Finkelsteyn, Ana Mariel; Saucedo, Miguel; Miquelini, Luis Ariel; Chertcoff, Aníbal; Bandeo, Lucrecia; Pacha, Sol; Cejas, Luciana León; Roca, Claudia Uribe; Pardal, Manuel Fernández; Reisin, Ricardo; Bonardo, Pablo

doi:10.1016/j.jocn.2019.03.025

Cited by 14 publications

(16 citation statements)

References 34 publications

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“…Hand knob stroke is often considered an uncommon type of stroke with an incidence rate less than 1% [6,10]. In the present study, hand knob stroke accounted for 0.9% of all acute strokes, which was consistent with previous reports.…”

Section: Discussionsupporting

confidence: 93%

“…Thus, patients with hand knob stroke can easily be misdiagnosed as "peripheral neuropathy" and get the delayed or improper management [3,4]. Until present, data on hand knob stroke are still mostly limited to case reports or small series worldwide [5][6][7], while only a few cases have been reported in China, which may be related to the lack of clinical awareness of the disease. Therefore，this study analyzed the clinical characteristics, stroke etiology and prognosis of 19 patients with hand knob stroke in China, in order to improve clinicians' knowledge of the uncommon stroke at the specific site and guide the clinical practice.…”

Section: Introductionmentioning

confidence: 99%

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Clinical features, etiology, and prognosis of hand knob stroke: a case series

et al. 2022

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Background Hand knob stroke is a rare clinical disorder frequently misdiagnosed as peripheral neuropathy. The purpose of this study is to recognize this particular type of stroke by analyzing clinical features, etiology, and prognosis. Methods We enrolled 19 patients with acute hand knob stroke in the Department of Neurology of the Beijing Geriatric Hospital from January 2018 to January 2022, and the clinical and imaging data of the patients during hospitalization and follow-up were collected and summarized. Results Acute hand knob stroke accounted for 0.9% of all acute stroke, and ischemic stroke (17 cases, 89.5%) was more than hemorrhagic stroke (2 cases, 10.5%). All patients presented sudden contralateral hand paresis, 12 (63.2%) of them had only isolated hand paralysis, and the location of the lesion corresponded to different finger weakness. The cause of hand knob hemorrhage was hypertension, while the causes of hand knob infarction were mainly small-vessel occlusion (SVO) (35.3%) and large-artery atherosclerosis (LAA) (35.3%), and the rare causes include carotid artery dissection and carotid body tumor. After a median follow-up 13.5 months, the prognosis of 94.7% patients was good, and one patient (5.3%) had recurrent stroke. Conclusions Hand knob stroke is a rare stroke with a good prognosis and a low stroke recurrence rate. Ischemic stroke is the predominant type and the main clinical manifestation is hand paresis. The cause of hand knob hemorrhage is hypertensive, while SVO and LAA are the main causes of hand knob infarction, but there are some rare etiologies.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Clinical features, etiology, and prognosis of hand knob stroke: a case series

et al. 2022

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“…The clinical presentation was in keeping with the sparse case reports and case series in the literature on CAE and ischaemic “hand-knob” stroke, in which the most frequently described symptoms are impaired consciousness [ 7 , 10 , 11 , 12 , 13 ] and predominantly left-sided focal motor deficits [ 10 , 12 , 13 , 15 , 16 , 17 , 19 ]. Sensory symptoms, i.e., hand hypo- or hyper-aesthesia, are also relatively common [ 16 , 18 , 20 ] and mostly occur in the absence of sensory deficits on neurological examination. They are believed to reflect subjective sensory disturbances secondary to motor dysfunction [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…It manifests as an isolated hand paresis and can be easily misdiagnosed for a lesion of the peripheral nervous system; thus, it has also been termed “pseudoperipheral palsy” [ 15 , 17 ]. It has been suggested to have a mainly embolic origin, from cardiac or large artery disease, and it has been shown to have a benign clinical course with no or mild residual deficits [ 16 , 17 , 18 , 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Ischaemic Stroke of the “Hand-Knob” Area Due to Paradoxical Cerebral Air Embolism after Central Venous Catheterization—A Doubly Rare Occurrence: A Case Report and an Overview of Pathophysiology, Diagnosis, and Treatment

et al. 2022

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Central venous catheters (CVCs) are increasingly used across specialties for invasive haemodynamic monitoring and for the delivery of fluids, medications, and nutritional support. Cerebral air embolism (CAE) is a rare but potentially fatal complication associated with the insertion, maintenance, and removal of CVCs. It can occur through different mechanisms, including the direct retrograde ascension of air into the cerebral veins and paradoxical embolism due to a right-to-left intracardiac or intrapulmonary shunt. The “hand-knob” area is the cortical region within the primary motor cortex that contains the representation of the hand. It is located in the superior precentral gyrus and is the site of less than 1% of all ischaemic strokes. We report here the case of a patient who experienced an ischaemic stroke of the right “hand-knob” area, due to paradoxical CAE through a previously undiagnosed patent foramen ovale (PFO), after the insertion of a catheter in the right internal jugular vein. We also provide an overview of the pathophysiology, diagnosis, and treatment of CAE. Suspecting CAE in the case of an acute neurological event occurring in close temporal relationship with central venous catheterization is paramount to allow the early recognition and treatment of this uncommon form of iatrogenic stroke.

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“…This case series covered a time span of five years involving 866 ischemic strokes at this institution, providing an ischemic stroke rate of 1.5% involving the hand knob gyrus [ 10 ]. In another case series of 11 subjects collected over a three-year period from 339 ischemic strokes, the most common etiology was cryptogenic, namely embolic stroke of undetermined cause (seven patients), and two definite cardioembolic ischemic strokes [ 11 ]. Again, the prognosis was excellent.…”

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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Ischemic stroke of the “hand knob area”: A case series and literature review

Cited by 14 publications

References 34 publications

Clinical features, etiology, and prognosis of hand knob stroke: a case series

Clinical features, etiology, and prognosis of hand knob stroke: a case series

Ischaemic Stroke of the “Hand-Knob” Area Due to Paradoxical Cerebral Air Embolism after Central Venous Catheterization—A Doubly Rare Occurrence: A Case Report and an Overview of Pathophysiology, Diagnosis, and Treatment

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

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