Hand knob stroke from cancer-associated thromboembolism

A 72-year-old man undergoing chemotherapy with 4 cycles of gemcitabine and nabpaclitaxel for pancreatic ductal adenocarcinoma, diagnosed 5 months previously, presented to the emergency department with sudden difficulty moving his left hand. Neurological examination showed paresis of extension of the...

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Bibliographic Details
Published in:Canadian Medical Association journal (CMAJ) 2019-10, Vol.191 (42), p.E1164-E1164
Main Authors: Tomoda, Yoshitaka, Tanaka, Masahito, Tanaka, Kazutoyo
Format: Article
Language:English
Subjects:
Adenocarcinoma
Cancer
Cancer treatment
Chemotherapy
Development and progression
Diagnosis
Diagnostic imaging
Embolisms
Hand
Health aspects
Magnetic resonance imaging
Neurologic examination
NMR
Nuclear magnetic resonance
Pancreatic cancer
Paralysis
Practice
Pulmonary arteries
Risk factors
Statistics
Stroke
Thromboembolism
Thrombosis
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Summary:A 72-year-old man undergoing chemotherapy with 4 cycles of gemcitabine and nabpaclitaxel for pancreatic ductal adenocarcinoma, diagnosed 5 months previously, presented to the emergency department with sudden difficulty moving his left hand. Neurological examination showed paresis of extension of the left wrist. Weakness of all fingers of the left hand was present, including a teardrop sign from paresis of the finger flexors. Sensory examination results were normal. Diffusion-weighted brain magnetic resonance imaging (MRI) showed an acute infarction in the superior part of the patient's right precentral gyrus, called the hand knob area. Infarction in the hand knob area, the site of hand motor function, can cause isolated upper limb paresis and may be misdiagnosed as peripheral nerve damage. This is an uncommon presentation of acute stroke, with an incidence rate of < 1% among all ischemic strokes. This manifestation is typically associated with atheroembolism or cardioembolism.
ISSN:0820-3946
1488-2329
DOI:10.1503/cmaj.190673