A case report of isolated distal upper extremity weakness due to cerebral metastasis involving the hand knob area 11 Medical and Health Sciences 1109 Neurosciences

András Folyovich, Viktória Varga, György Várallyay, Lajos Kozák, Mária Bakos, Erika Scheidl, Katalin Anna Béres-Molnár, Zita Kajdácsi, D. Bereczki

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Unilateral 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 presentation: We 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. Conclusions: Pseudoperipheral 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.

Original languageEnglish
Article number947
JournalBMC Cancer
Volume18
Issue number1
DOIs
Publication statusPublished - Oct 3 2018

Fingerprint

Frontal Lobe
Neurosciences
Upper Extremity
Hand
Peripheral Nerves
Neoplasm Metastasis
Neural Conduction
Health
Neuroimaging
Paralysis
Radial Neuropathy
Mucinous Adenocarcinoma
Neoplasms
Lung
Motor Cortex
Infarction
Adenocarcinoma
Central Nervous System
Lymph Nodes
Stroke

Keywords

  • Brain metastasis
  • Hand knob
  • Isolated distal upper extremity weakness

ASJC Scopus subject areas

  • Oncology
  • Genetics
  • Cancer Research

Cite this

A case report of isolated distal upper extremity weakness due to cerebral metastasis involving the hand knob area 11 Medical and Health Sciences 1109 Neurosciences. / Folyovich, András; Varga, Viktória; Várallyay, György; Kozák, Lajos; Bakos, Mária; Scheidl, Erika; Béres-Molnár, Katalin Anna; Kajdácsi, Zita; Bereczki, D.

In: BMC Cancer, Vol. 18, No. 1, 947, 03.10.2018.

Research output: Contribution to journalArticle

Folyovich, András ; Varga, Viktória ; Várallyay, György ; Kozák, Lajos ; Bakos, Mária ; Scheidl, Erika ; Béres-Molnár, Katalin Anna ; Kajdácsi, Zita ; Bereczki, D. / A case report of isolated distal upper extremity weakness due to cerebral metastasis involving the hand knob area 11 Medical and Health Sciences 1109 Neurosciences. In: BMC Cancer. 2018 ; Vol. 18, No. 1.
@article{be4f440fe6274339a9cedbd4d49afd01,
title = "A case report of isolated distal upper extremity weakness due to cerebral metastasis involving the hand knob area 11 Medical and Health Sciences 1109 Neurosciences",
abstract = "Background: Unilateral 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 presentation: We 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. Conclusions: Pseudoperipheral 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.",
keywords = "Brain metastasis, Hand knob, Isolated distal upper extremity weakness",
author = "Andr{\'a}s Folyovich and Vikt{\'o}ria Varga and Gy{\"o}rgy V{\'a}rallyay and Lajos Koz{\'a}k and M{\'a}ria Bakos and Erika Scheidl and B{\'e}res-Moln{\'a}r, {Katalin Anna} and Zita Kajd{\'a}csi and D. Bereczki",
year = "2018",
month = "10",
day = "3",
doi = "10.1186/s12885-018-4857-9",
language = "English",
volume = "18",
journal = "BMC Cancer",
issn = "1471-2407",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - A case report of isolated distal upper extremity weakness due to cerebral metastasis involving the hand knob area 11 Medical and Health Sciences 1109 Neurosciences

AU - Folyovich, András

AU - Varga, Viktória

AU - Várallyay, György

AU - Kozák, Lajos

AU - Bakos, Mária

AU - Scheidl, Erika

AU - Béres-Molnár, Katalin Anna

AU - Kajdácsi, Zita

AU - Bereczki, D.

PY - 2018/10/3

Y1 - 2018/10/3

N2 - Background: Unilateral 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 presentation: We 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. Conclusions: Pseudoperipheral 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.

AB - Background: Unilateral 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 presentation: We 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. Conclusions: Pseudoperipheral 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.

KW - Brain metastasis

KW - Hand knob

KW - Isolated distal upper extremity weakness

UR - http://www.scopus.com/inward/record.url?scp=85054348540&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85054348540&partnerID=8YFLogxK

U2 - 10.1186/s12885-018-4857-9

DO - 10.1186/s12885-018-4857-9

M3 - Article

C2 - 30285670

AN - SCOPUS:85054348540

VL - 18

JO - BMC Cancer

JF - BMC Cancer

SN - 1471-2407

IS - 1

M1 - 947

ER -