갈퀴손처럼 발현한 중심앞이랑 국소피질뇌경색

Claw-Hand Caused by a Small Cortical Infarction in the Precentral Gyrus

Article information

J Korean Neurol Assoc. 2018;36(3):254-255
Publication date (electronic) : August 1, 2018
doi : http://dx.doi.org/10.17340/jkna.2018.3.28
Department of Neurology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
양지원, 최석홍, 김현석, 신동훈
가천대학교 의과대학 길병원 신경과
Address for correspondence: Dong Hoon Shin, MD Department of Neurology, Gil Medical Center, Gachon University College of Medicine, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 21565, Korea Tel:+82-32-460-3346 Fax: +82-32-460-3344 E-mail: dr.donghoon.shin@gmail.com
received : March 6, 2018 , rev-recd : March 30, 2018 , accepted : March 30, 2018 .

69세 여자가 당일 갑자기 발생한 우측 4번, 5번 손가락 위약감으로 응급실에 왔다. 10년간 당뇨약을 복용한 병력이 있었다. 신경학적진찰에서 갈퀴손처럼 우측 4번, 5번 손가락 뼈 사이 관절이 굽어있으면서 원위/근위손가락 뼈 사이 관절의 굽힘근과 폄근 위약이 Medical Research Council 4등급(grade IV) 정도로 있었고 다른 운동 및 감각 이상은 관찰되지 않았다(Fig. 1). 확산강조영상에서 좌측 중심앞이랑 피질 부위에 국소 급성뇌경색이 확인되었고(Fig. 2-A), 혈관조영술에서 좌측 내경동맥 근위부 협착이 관찰되었다(Fig. 2-B). 환자의 손 모양과 손가락 힘은 입원 6일째 이전처럼 회복되었고, 같은 날 시행한 팔꿈치 주위의 분절검사를 포함한 척골신경전도검사는 정상이었다. 본 환자는 일과성 압박척골신경병이 생길만한 유발인자와 상황이 없었고 전형적인 갈퀴손 모양과 달리 중수지관절의 과도한 신전이나 위약이 보이지 않았던 점 때문에 급성뇌경색에 의한 증상이었을 가능성이 높다고 생각된다. 특히 중심앞이랑에 위치한 손운동피질의 병터에 의해 손이나 손가락 위약이 발생할 수 있으며[1] 특정 손가락 위주(척골 또는 요골측 우세)로 나타날 수 있다[2].

Figure 1.

Claw-hand like deformity of the patient. Mild extension and flexion weakness of right 4th and 5th finger was seen on the admission day (A). After 6 days, symptom was almost resolved (B).

Figure 2.

Brain diffusion weighted image (DWI) with apparent diffusion coefficient (ADC) and carotid artery magnetic resonance angiography on the admission day. (A) Small diffusion restriction in the left precentral gyrus and corresponding low ADC map were seen (white arrows). (B) Stenosis in the left proximal internal carotid artery was seen (white arrow).

References

1. Yousry TA, Schmid UD, Alkadhi H, Schmidt D, Peraud A, Buettner A, et al. Localization of the motor hand area to a knob on the precentral gyrus. A new landmark. Brain 1997;120(Pt 1):141–157.
2. Kim JS. Predominant involvement of a particular group of fingers due to small, cortical infarction. Neurology 2001;56:1677–1682.

Article information Continued

Figure 1.

Claw-hand like deformity of the patient. Mild extension and flexion weakness of right 4th and 5th finger was seen on the admission day (A). After 6 days, symptom was almost resolved (B).

Figure 2.

Brain diffusion weighted image (DWI) with apparent diffusion coefficient (ADC) and carotid artery magnetic resonance angiography on the admission day. (A) Small diffusion restriction in the left precentral gyrus and corresponding low ADC map were seen (white arrows). (B) Stenosis in the left proximal internal carotid artery was seen (white arrow).