Downloaded from http://emj.bmj.com/ on March 10, 2015 - Published by group.bmj.com Images in emergency medicine Benedictine hand of ‘central’ origin A 67-year-old man was admitted to emergency room to investigate a left hand weakness started on awakening. Anamnesis revealed only a mild hypertension currently treated with ACE-inhibitors. Antigravitary tests in upper limbs showed a ‘benedictine’ hand (figure 1A,B). Sensory examination was unremarkable although the patient complained of nocturnal paraesthesias in left hand. Brain CT scan was negative. Initial diagnosis was ischaemic stroke even if a proximal median nerve injury was mimicked. Nerve conduction study and electromyographic examination of left arm, performed the day after, showed only a ‘mild’ carpal tunnel syndrome. Brain MRI, obtained 2 days after the onset of symptoms, confirmed a lesion of the right precentral and postcentral gyri, compatible with acute ischaemia (figure 1C,D). The patient was discharged with antiplatelet therapy; hand weakness fully disappeared within 2 months. Ischaemic events mimicking peripheral nerve disorders have been rarely reported.1 Generally small hand muscles are affected and post-central gyrus (Brodmann area 4) is involved.1 With the improvement of MRI technique in detecting also minimal ischaemic lesions the correct diagnosis of these disorders has become crucial in order to look for potential thromboembolic sources and treat risk factors that would prevent further strokes. Marco Luigetti,1 Federico Ranieri,1 Paolo Profice,1 Fabio Pilato,1 Fioravante Capone,1 Vincenzo Di Lazzaro2 1 Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy; 2Department of Neuroscience, Campus Biomedico University of Rome, Rome, Italy Correspondence to Dr Marco Luigetti, Institute of Neurology, Largo F. Vito 1, 00168 Roma, Italy; mluigetti@gmail.com Contributors Drafting/revising the manuscript for content, including medical writing for content. Dr Luigetti, Dr Ranieri, Dr Profice, Dr Pilato, Dr Capone, Prof Di Lazzaro. Study concept or design. Dr Luigetti, Dr Ranieri, Prof Di Lazzaro. Analysis or interpretation of data. Dr Luigetti, Dr Ranieri, Dr Profice, Dr Pilato, Dr Capone, Prof Di Lazzaro. Acquisition of data. Dr Luigetti, Dr Ranieri, Dr Profice, Dr Pilato, Dr Capone, Prof Di Lazzaro. Study supervision or coordination. Dr Luigetti, Dr Ranieri, Prof Di Lazzaro. Competing interests None. Patient consent Obtained. Provenance and peer review Not commissioned; internally peer reviewed. Accepted 2 May 2012 Published Online First 28 May 2012 Emerg Med J 2013;30:173. doi:10.1136/emermed-2012-201490 REFERENCE 1. Rankin EM, Rayessa R, Keir SL. Pseudoperipheral palsy due to cortical infarction. Age Ageing 2009;38:623e4. Figure 1 Antigravitary test of upper limbs showing a left benedictine hand (A, B). Brain MRI (C, D): diffusion-weighted imaging axial sequence showing restricted diffusion in the right precentral and postcentral gyri suggesting acute ischaemia (D); axial T2-FLAIR image (C) showing hyperintense signal in the same region. Emerg Med J February 2013 Vol 30 No 2 173 Downloaded from http://emj.bmj.com/ on March 10, 2015 - Published by group.bmj.com Benedictine hand of 'central' origin Marco Luigetti, Federico Ranieri, Paolo Profice, Fabio Pilato, Fioravante Capone and Vincenzo Di Lazzaro Emerg Med J 2013 30: 173 originally published online May 28, 2012 doi: 10.1136/emermed-2012-201490 Updated information and services can be found at: http://emj.bmj.com/content/30/2/173 These include: References Email alerting service Topic Collections This article cites 1 articles, 1 of which you can access for free at: http://emj.bmj.com/content/30/2/173#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article. Articles on similar topics can be found in the following collections Stroke (222) Hypertension (280) Ethics (368) Clinical diagnostic tests (989) Pain (neurology) (945) Radiology (939) Radiology (diagnostics) (846) Trauma (985) Workplace injury (4) Notes To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/