Hand Monoparesis Due to Small Cortical Ischemic Stroke, Etiology, Prognosis and Medical Management: Case Report and Literature Review

Paula Eboli, Asma Moheet, Shlee Song, Robert Ryan, Michael Alexander


We present the case of a 70-year-old male who presented to Cedars Sinai Emergency room with sudden onset of right hand weakness. Only a few cases of hand weakness due to a small cortical stroke have been previously reported. Brain MRI showed acute small, ischemic infarction in the left right precentral gyrus and CTA showed 75% stenosis at the origin of the left internal carotid. After discussing possible risks and benefits, he received IV rTPA and underwent subsequent carotid endarterectomy a few days later. Our paper highlights the importance of considering small cortical strokes in patients with sudden onset of hand weakness since these patients may benefit from IV administration of rTPA and early intervention to treat embolic source and prevent future ischemic events.

J Med Cases. 2013;4(6):429-432
doi: https://doi.org/10.4021/jmc1283w


Cortical stroke; Omega sign; Distal embolic strokes

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