EMedHome's Clinical Pearl
Isolated hand or finger palsy is not included in the NIH Stroke Scale, which is a weakness of the tool because this type of palsy is a disabling clinical condition and could be an indicator of acute ischemic stroke. (West J Emerg Med 2018;19:524; http://bit.ly/2OCzVW5.)
The incidence of acute stroke with isolated hand paresis is not known, but it appears to constitute from 0.83 percent to 1.5 percent of all ischemic strokes. (Cerebrovasc Dis Extra 2013;3:65; http://bit.ly/2OzrQ4k.) A paralysis of the hand and fingers without sensory deficit is due to cortical infarction of the precentral dial knob, a segment of the precentral gyrus that projects to the middle genu of the central sulcus. (Neurology 2001;56:1677.) Embolic mechanisms are more often associated with small cortical infarction associated with isolated hand or finger palsy. (West J Emerg Med 2018;19:524; http://bit.ly/2OCzVW5; Neurology 2001;56:1677.)
Clinicians must consider that patients with isolated hand palsy may have an alternative explanation, including a history of pain suggesting vasculitis, waking from sleep with the deficit (compression), a fall (trauma), and shoulder (neuralgic amyotrophy) or neck pain with radicular symptoms. The patient should be aggressively evaluated and treated for acute ischemic stroke if these findings are absent. (West J Emerg Med 2018;19:524; http://bit.ly/2OCzVW5.)
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