Isolated Hand Paresis: A Case Series
Case 7. A 76-year-old female with hypertension and paroxysmal atrial fibrillation noticed sudden loss of fine motor control in the two ulnar fingers of the left hand, and 4 days later of the whole hand. On admission, her international normalized ratio was 2.8. A small loss of speed and power (MRC score 5-; online suppl. video ; for all online suppl. material, see ) of the hand and fingers was found. ECG showed atrial fibrillation, but transthoracic echocardiography revealed no cardiac thrombus. MRI revealed two minor ischemic lesions: one in the right semiovale center and one in the right motor cortex (fig. ). A highly significant carotid stenosis was found, and the patient underwent endarterectomy. According to the TOAST classification, the presence of LAA and the high risk of CE are mutually exclusive, and consequently this type of stroke should be classified as SUE. However, in this case LAA was considered probable. On follow-up 32 months later, the clinical status was unchanged (mRS 1).