A small stroke in the precentral gyrus affecting motor control of the hand or foot can result in a limited muscle deficit. The cortical area for the hand is referred to as the hand knob.
If the deficit affects a hand or finger, then it is termed the cortical hand syndrome.
If the deficit affects a foot or toe, then it is termed the cortical foot syndrome.
Presentation in hand:
(1) weakness limited to 1 to 5 fingers
(2) hand weakness
(3) deficits in point localization, stereognosis and graphesthesia
Presentation in foot:
(1) isolated foot drop
(2) weakness in the toes
(3) deficits in point localization, stereognosis and graphesthesia
The causal microemboli may come from a heart valve or carotid artery. Changes in imaging studies may be subtle if the area affected is very small.
The diagnosis can be challenging. Common misdiagnoses:
(1) peripheral neuropathy (radial or ulnar if hand affected)
(2) herniated disc
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