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Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Erschienen in:

03.10.2023 | Case Reports / Case Series

Perioperative cortical hand stroke syndrome mimicking peripheral neuropathy: a case report

verfasst von: Jeronimo Chapur, MD, Katarina Kojic, MD, FRCPC, Matthew Kula, MD, MSC, FRCPC, Alana M. Flexman, MD, MBA, FRCPC

Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 11/2023

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Abstract

Purpose

Timely diagnosis of perioperative stroke is challenging, and therapeutic interventions are infrequently offered. The cortical hand syndrome is a rare stroke presentation that results from infarction of the precentral gyrus leading to variable neurologic deficits mimicking peripheral nerve injuries, with no prior reports in the perioperative setting. To raise awareness of this complication among anesthesiologists, we present a case of cortical hand syndrome in a surgical patient initially suspected to have a peripheral neuropathy.

Clinical features

A 68-yr-old male with multiple stroke risk factors underwent a nephroureterectomy under general anesthesia and thoracic epidural analgesia for urothelial carcinoma. The patient noted right-hand numbness and weakness to digits 3–5 immediately after surgery and notified his bedside nurse the following day. His symptoms were initially presumed to be a peripheral neuropathy secondary to surgical positioning. Computed tomography of the head the following day revealed an acute cortical infarct in the precentral gyrus consistent with cortical hand stroke syndrome. Subsequent neurologic consultation revealed additional subtle right-sided weakness. Further workup revealed moderate (60–80%) stenosis of the left carotid artery and he underwent a successful carotid endarterectomy one week later. His symptoms had mostly resolved six weeks later.

Conclusion

Cortical hand stroke syndrome is a rare presentation of perioperative stroke that may be misdiagnosed as a peripheral neuropathy. Our case presentation highlights that perioperative stroke should be considered for patients presenting with neurologic deficits of the hand, particularly those with deficits in multiple peripheral nerve territories and stroke risk factors.

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Titel: Perioperative cortical hand stroke syndrome mimicking peripheral neuropathy: a case report
verfasst von: Jeronimo Chapur, MD
Katarina Kojic, MD, FRCPC
Matthew Kula, MD, MSC, FRCPC
Alana M. Flexman, MD, MBA, FRCPC
Publikationsdatum: 03.10.2023
Verlag: Springer International Publishing
Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Ausgabe 11/2023
Print ISSN: 0832-610X
Elektronische ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-023-02587-z

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Perioperative cortical hand stroke syndrome mimicking peripheral neuropathy: a case report