Perioperative cortical hand stroke syndrome mimicking peripheral neuropathy: a case report,Canadian Journal of Anesthesia

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Perioperative cortical hand stroke syndrome mimicking peripheral neuropathy: a case report
Canadian Journal of Anesthesia ( IF 3.4 ) Pub Date : 2023-10-03 , DOI: 10.1007/s12630-023-02587-z
Jeronimo Chapur _{1,

2} , Katarina Kojic _{3,

4} , Matthew Kula _{5,

6} , Alana M Flexman _{3,

4,

7}

Affiliation

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.

中文翻译：

围手术期皮质手卒中综合征类似周围神经病变：病例报告

目的

围手术期卒中的及时诊断具有挑战性，并且很少提供治疗干预措施。皮质手综合征是一种罕见的中风表现，由中央前回梗塞导致，导致类似于周围神经损伤的可变神经功能缺损，此前在围手术期没有相关报道。为了提高麻醉医师对这种并发症的认识，我们介绍了一名最初怀疑患有周围神经病变的外科患者的手皮质综合征病例。

临床表现

一名患有多种中风危险因素的 68 岁男性因尿路上皮癌在全身麻醉和胸段硬膜外镇痛下接受了肾输尿管切除术。手术后，患者立即发现右手麻木且无力，并于第二天通知了床边护士。他的症状最初被认为是继发于手术定位的周围神经病变。第二天的头部计算机断层扫描显示中央前回有急性皮质梗塞，与皮质手中风综合征一致。随后的神经科咨询显示出额外的轻微右侧无力。进一步检查显示左颈动脉中度狭窄（60-80%），一周后他成功接受了颈动脉内膜切除术。六周后，他的症状基本消失。