Cortical-hand syndrome

Isolated hand weakness (the cortical-hand syndrome) is a well-recognised, but rare presentation of stroke. The lesion has been isolated to the 'precentral knob' of the motor cortex of the brain. An embolic stroke mechanism has been considered the most frequent cause. The prognosis for recovery of hand function is considered good. A clinical diagnosis is imperative to decide on appropriate investigations and treatment. We describe a middle-aged man who presented with sudden-onset, isolated, global weakness of his left hand with a corresponding cortical infarct to illustrate the key clinical and radiological features in the diagnosis of the cortical-hand syndrome.