Strategic cortical lesions involving the hand motor cortex (HMC) presenting acutely as distal upper limb pure motor weakness certainly do need to be differentiated on clinical grounds from “pseudoperipheral palsy.” This rare phenotype can imitate peripheral motor nerve deficits and should not be easily overlooked. The? isolated “central hand and finger weakness” presenting as an acute onset of varying combinations such as pseudomedian, pseudoradial, and/or pseudoulnar nerve palsy is intriguing to the novice. In literature, this phenotype has been reported solely to result from cortical cerebral infarction and documented to occur in <1% of all ischemic strokes. The apropos of six “unforgettable patients” here highlights the heterogeneous pathophysiologic etiologies and mechanisms that included not only the conventional stroke risk factors but also hyperhomocysteinemia, common carotid artery thrombosis due to hyperhomocysteinemia and severe iron-deficiency anemia, biopsy-proven giant cell arteritis (GCA), cerebral metastasis, and dilated cardiomyopathy-related left ventricular thrombosis. Physicians and neurologists alike, as clinicians, need to be familiar with the peculiarities and clinical presentations of central hand control network cortical lesions.


中文翻译：

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伪装成“假性周围神经麻痹”的选择性手运动皮层病变


涉及手运动皮质（HMC）的战略性皮层损害，由于上肢远端纯粹的运动无力而呈现为急性，因此确实需要根据临床原因与“假性周围性麻痹”加以区分。这种罕见的表型可以模仿周围运动神经的缺陷，因此不容忽视。该？对新手而言，孤立的“中枢手和手指无力”表现为各种组合的急性发作，例如假中位，假radi骨和/或假尺神经麻痹。在文献中，该表型仅报道为由皮层脑梗塞引起，并记录在所有缺血性卒中的<1％中。这里有六名“难忘的病人”，他们强调了多种病理生理学病因和机制，不仅包括传统的中风危险因素，还包括高同型半胱氨酸血症，高同型半胱氨酸血症和严重铁缺乏性贫血引起的颈总动脉血栓形成，经活检证实的巨细胞性动脉炎（ GCA），脑转移和扩张型心肌病相关的左心室血栓形成。像临床医生一样，内科医生和神经科医生也需要熟悉中央手控网络皮层病变的特点和临床表现。