rss
Emerg Med J 30:173 doi:10.1136/emermed-2012-201490
  • Images in emergency medicine

Benedictine hand of ‘central’ origin

  1. Vincenzo Di Lazzaro2
  1. 1Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy
  2. 2Department of Neuroscience, Campus Biomedico University of Rome, Rome, Italy
  1. Correspondence to Dr Marco Luigetti, Institute of Neurology, Largo F. Vito 1, 00168 Roma, Italy; mluigetti{at}gmail.com
  1. Contributors Drafting/revising the manuscript for content, including medical writing for content. Dr Luigetti, Dr Ranieri, Dr Profice, Dr Pilato, Dr Capone, Prof Di Lazzaro. Study concept or design. Dr Luigetti, Dr Ranieri, Prof Di Lazzaro. Analysis or interpretation of data. Dr Luigetti, Dr Ranieri, Dr Profice, Dr Pilato, Dr Capone, Prof Di Lazzaro. Acquisition of data. Dr Luigetti, Dr Ranieri, Dr Profice, Dr Pilato, Dr Capone, Prof Di Lazzaro. Study supervision or coordination. Dr Luigetti, Dr Ranieri, Prof Di Lazzaro.

  • Accepted 2 May 2012
  • Published Online First 28 May 2012

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.

Figure 1

Antigravitary test of upper limbs showing a left benedictine hand (A, B). Brain MRI (C, D): diffusion-weighted imaging axial sequence showing restricted diffusion in the right precentral and postcentral gyri suggesting acute ischaemia (D); axial T2-FLAIR image (C) showing hyperintense signal in the same region.

Ischaemic events mimicking peripheral nerve disorders have been rarely reported.1 Generally small hand muscles are affected and post-central gyrus (Brodmann area 4) is involved.1 With the improvement of MRI technique in detecting also minimal ischaemic lesions the correct diagnosis of these disorders has become crucial in order to look for potential thromboembolic sources and treat risk factors that would prevent further strokes.

Footnotes

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.

Reference


Free sample
This recent issue is free to all users to allow everyone the opportunity to see the full scope and typical content of EMJ.
View free sample issue >>

Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.

Poll

Among patients with minor TBI (GCS 13-15) getting CT scans ≥ 24 hours after injury, what proportion have a traumatic finding?

Results

0.5% - 43% response rate
3% - 41% response rate
10% - 16% response rate

Related original article: PCT head imaging in patients with head injury who present after 24 h of injury: a retrospective cohort study

Navigate This Article