European Journal of Neurology 2006, 13: e6 doi:10.1111/j.1468-1331.2006.01304.x LETTER TO THE EDITOR Dysarthria-clumsy hand syndrome originating in the corona radiata Y. Iguchia, K. Kimuraa, Y. Uenoa, T. Inouea, N. Matusmotoa and Y. Sunadab a Department of Stroke Medicine, Stroke Center, Kawasaki Medical School, Kurashiki City, Japan; and bDepartment of Neurology, Kawasaki Medical School, Kurashiki City, Japan Correspondence: Dr Yasuyauki Iguchi, Department of Stroke Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki-city, Okayama 701-0192, Japan (tel.: +81 86 462 1111; fax: +81 86 462 1199; e-mail: yigu@med.kawasakim.ac.jp). Keywords: Corona radiata, Diffusionweighted magnetic resonance imaging, Dysarthria-clumsy hand syndrome, Lacunar infarction Received 14 April 2005 Accepted 19 June 2005 A 61-year-old hypertensive man was admitted to our hospital with writing difficulties and speech disturbance. On admission, neurological examination revealed left facial weakness was equivocal and mild pronator drift of the right arm was noted without leg weakness. Dysarthria-clumsy hand syndrome (DCHS) was now diagnosed. The patient was examined with a 1.5-T magnetic resonance imaging (MRI) unit (Signa EchoSpeed Horizon; GE Medical Systems, Milwaukee, WI, USA). Diffusion weighted MR imaging (DWI) revealed a hyperintense lesion involving the left corona radiata (Fig. 1), and was identified as the lesion responsible for DCHS. The lesion in the corona radiata was diagnosed as lacunar infarct. The present case clearly demonstrated lacunar infarction involving the corona radiata in a patient with DCHS. To the best of our knowledge, this is the first case with DCHS in which DWI clearly demonstrated fresh lesions in the corona radiata. Numerous cases of DCHS have been reported since Fisher first described lacunar syndromes [1]. Donnan et al. [2] reported that DCHS was present in six of 69 cases with the internal capsule infarction. Arboix et al. [3] studied that the present lesions of 35 cases with DCHS and showed that the internal capsule was found in 16 cases, but corona radiata was in only three cases. However, previous studies have not used DWI, and might thus be unreliable for determining whether lesions were acute and corresponding to neurological manifestations. Schonewille et al. [4] assessed 43 acute stroke patients with classical lacunar syndromes using DWI and reported that DCHS was seen in only two cases (Case 1 in the posterior limb of the internal capsule; Case 2 in the caudate nucleus). In light of the present report and that of Schonewille et al. [4], DCHS with acute ischemic stroke displayed responsible lesions not only in the internal capsule, but also in the corona radiata. The present report indicates that DWI could completely exclude the unreliable lesions and clearly demonstrate the involvement in corona radiata. In conclusion, this report provides new and important information on the neuroimaging for DCHS in acute ischemic stroke. DWI may help to verify unclear correlations between the neurological manifestation and responsible lesion in DCHS. References 1. Fisher CM, Cole M. Homolateral ataxia and crural paresis: a vascular syndrome. Journal of Neurology, Neurosurgery and Psychiatry 1965; 28: 48–55. 2. Donnan GA, Tress BM, Bladin PF. A prospective study of lacunar infarction using computerized tomography. Neurology 1982; 32: 49–56. 3. Arboix A, Bell Y, Garcia-Eroles L, et al. Clinical study of 35 patients with dysarthriaclumsy hand syndrome. Journal of Neurology, Neurosurgery and Psychiatry 2004; 75: 231–234. 4. Schonewille WJ, Tuhrim S, Singer MB, Atlas SW. Diffusion-weighted MRI in acute lacunar syndromes. A clinical-radiological correlation study. Stroke 1999; 30: 2066–2069. Figure 1 Axial diffusion-weighted magnetic resonance imaging shows hyperintensity in the corona radiata on initial hospitalization. e6 Ó 2006 EFNS