Document Type
Case Report
Disciplines
Higher Education | Medicine and Health Sciences
Abstract
Background. Hand knob strokes present with unilateral motor weakness of the hand, distal arm, or a particular group of fingers with or without paresthesia. This condition can easily be misdiagnosed as a peripheral mononeuropathy without a high level of suspicion and a thorough history and physical exam. We present a case of hand knob stroke that mimicked an ulnar mononeuropathy.
Case. A 100-year-old male with a history of untreated hypertension, Stage 3A Chronic Kidney Disease, and prediabetes presented to the hospital five hours after symptom onset with resolving acute left hand weakness and paresthesia. Symptoms began the night prior with sudden left-hand motor loss lasting three hours, followed by paresthesias in the left 4th and 5th digits. Initial blood pressure was 183/70, and the National Institutes of Health Stroke Scale was 0.
The patient was alert and fully oriented, with 4/5 strength in the left deltoid and finger abduction. Froment’s and Tinel’s signs over Guyon’s canal were positive, Spurling’s was negative, left pronator drift was observed, and sensation was intact in all extremities. Computed Tomography Angiography showed mild right internal carotid artery stenosis. Magnetic resonance imaging revealed tiny acute cortical infarcts in the right frontal lobe, chronic small-vessel ischemia, and tiny chronic left cerebellar infarcts, as well as chronic right thalamic microhemorrhage related to hypertension. Echocardiogram showed preserved ejection fraction with grade 1 diastolic dysfunction. The electrocardiogram showed sinus rhythm with occasional premature ventricular contractions.
Diagnosed with hand knob stroke, the patient was prescribed aspirin and atorvastatin for secondary stroke prevention. Carvedilol was started for blood pressure control and PVCs. A 30-day event monitor was recommended to evaluate for embolic sources, and he was discharged with cardiology and neurology follow-ups.
Conclusion. Hand knob strokes account for approximately 1% of all ischemic strokes. Although uncommon, prompt diagnosis and appropriate treatment remain imperative to optimize functional outcomes and decrease the risk of future cerebrovascular accidents.
DOI
10.32873/unmc.dc.gmerj.8.1.005
Keywords
Stroke, hand knob infarct, case report
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.
Recommended Citation
Osborne, L. A., , Chien, S. Hand Knob Stroke, the Ultimate Mimic of Peripheral Mononeuropathy: A Case Report. Graduate Medical Education Research Journal. 2026 Jun 30; 8(1).
https://digitalcommons.unmc.edu/gmerj/vol8/iss1/5
