'Cortical Hand' in the Emergency Department: Two Case Reports.

BACKGROUND

Cortical hand strokes affect the 'hand knob' of the motor cortex, resulting in isolated distal upper limb or hand weakness. They are rare and can be easily misdiagnosed for peripheral lesions.

CASE REPORTS: Case 1: A 59-year-old man presented to the Emergency Department (ED) after noticing left hand weakness while driving. There was no sensory deficit noted. A full neurological examination suggested an upper motor neurone rather than a peripheral nerve lesion. This was confirmed by a magnetic resonance imaging scan of his brain. Case 2: An 88-year-old man presented to the ED after developing sudden-onset left hand weakness while completing a newspaper puzzle. Power returned gradually over approximately 4 h, with no sensory symptoms being noted. A transient ischemic attack leading to cortical hand was diagnosed. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Cortical hand strokes are a rare, but important, differential for wrist drop. They are often first strokes and embolic in nature. Therefore, correct diagnosis is vital to enable initiation of secondary prevention.