Benedictine hand of ‘central’ origin
- Marco Luigetti1,
- Federico Ranieri1,
- Paolo Profice1,
- Fabio Pilato1,
- Fioravante Capone1,
- Vincenzo Di Lazzaro2
- 1Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy
- 2Department of Neuroscience, Campus Biomedico University of Rome, Rome, Italy
- Correspondence to Dr Marco Luigetti, Institute of Neurology, Largo F. Vito 1, 00168 Roma, Italy;
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
- MR neurography
- nerve conduction studies
- thoracic outlet syndrome
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 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.
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; internally peer reviewed.