[Bilateral wrist drop - central or peripheral lesion?]

Fortschr Neurol Psychiatr. 2011 May;79(5):304-6. doi: 10.1055/s-0031-1273331. Epub 2011 May 3.
[Article in German]

Abstract

The wrist drop, also called carpoptosis or drop hand, is a common clinical presentation in case of peripheral damage to the radial nerve. But what about the picture of a bilateral finger/wrist drop?! We report the case of a 61-year-old female patient who was admitted to the hospital for myocardial infarction. Subsequently she developed a right dominant bilateral wrist drop. Further neurological examination revealed a positive Wartenberg sign pointing towards a central motoric dysfunction. The following native cerebral CT scan demonstrated bilateral hypodense lesions in both hand knobs in the precentral gyri. Subsequent MRI confirmed acute cerebral infarction in these two but also several other, clinically silent, locations. Further diagnostic work-up revealed a hypokinetic cardiac apex suggesting cardiac embolism to be the cause for cerebral thrombembolism and the clinically leading symptom of right-dominant bilateral finger/wrist drop. Besides the case presentation also the differential diagnosis and clinical test for diagnostic work-up of wrist drops are presented and discussed.

Publication types

  • Case Reports
  • English Abstract

MeSH terms

  • Angiography
  • Central Nervous System / pathology*
  • Cerebral Infarction / complications
  • Diagnosis, Differential
  • Electrodiagnosis
  • Female
  • Humans
  • Intracranial Embolism / complications
  • Magnetic Resonance Imaging
  • Middle Aged
  • Myocardial Infarction / complications
  • Neurologic Examination
  • Peripheral Nerves / pathology*
  • Radial Neuropathy / diagnosis
  • Radial Neuropathy / pathology*
  • Tomography, X-Ray Computed
  • Wrist / pathology*