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Arquivos de Neuro-Psiquiatria

versão impressa ISSN 0004-282Xversão On-line ISSN 1678-4227

Arq. Neuro-Psiquiatr. vol.76 no.1 São Paulo jan. 2018

http://dx.doi.org/10.1590/0004-282x20170164 

IMAGES IN NEUROLOGY

“Acute Dupuytren’s contracture”: the answer is not always in your hands

“Contractura de Dupuytren Aguda”: a resposta nem sempre está nas mãos

Tiago Geraldes1 

Rui Carvalho2 

Miguel Grunho1 

Carolina Pires1 

Ana Cláudia Ribeiro1 

1Hospital Garcia de Orta, Departamento de Neurologia, Almada, Portugal;

2Hospital Garcia de Orta, Departamento de Neurorradiologia, Almada, Portugal.

A 56-year-old man with prior left hand Dupuytren’s contracture suddenly developed a right hand Dupuytren’s contracture-like posturing (Figure A). Bilateral palmar fascial thickening with flexion deformity of the fingers was noted. Neurological examination also disclosed weakness of the right wrist and finger extension, as well as of thumb and index finger abduction. Brain MRI revealed an acute infarction in the left precentral “hand knob” area1,2,3,4 (Figure B, C and D). We emphasize that Dupuytren’s contracture, a supposedly straightforward orthopedic disorder, can be a stroke chameleon. By unbalancing a previous subclinical condition, due to predominant weakness in the extensors, cortical “hand knob” infarction presented as an “acute Dupuytren’s contracture” in this patient.

Figure A) Right hand “acute Dupuytren’s contracture-like posturing” with concomitant prior left Dupuytren’s contracture; B) Axial DWI; C) Axial ADC; D) Axial T2 FLAIR. 

References

1. Back T, Mrowka M. Infarction of the “hand knob” area. Neurology. 2001;57(6):1143. https://doi.org/10.1212/WNL.57.6.1143Links ]

2. Manjaly Z, Luft AR, Sarikaya H. An unusual cause of pseudomedian nerve palsy. Case Rep Neurol Med. 2011;2011:474271. https://doi.org/10.1155/2011/474271Links ]

3. Alstadhaug KB, Sjulstad A. Isolated hand paresis: a case series. Cerebrovascular Diseases Extra. 2013;3(1):65-73. https://doi.org/10.1159/000350708Links ]

4. Jusufovic M, Lygren A, Aamodt AH, Nedregaard B, Kerty E. Pseudoperipheral palsy: a case of subcortical infarction imitating peripheral neuropathy. BMC Neurology. 2015;15(1):151. https://doi.org/10.1186/s12883-015-0409-yLinks ]

Recebido: 18 de Novembro de 2016; Aceito: 11 de Agosto de 2018

Correspondence: Tiago Geraldes; Hospital Garcia de Orta; Av. Torrado da Silva, Almada, Setúbal, 2801-951, Portugal; E-mail: tgeraldes@yahoo.com

Conflict of interest: There is no conflict of interest to declare.

Creative Commons License  This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.