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“Hand Knob” infarction
  1. J Hall,
  2. A C Flint
  1. University of California, San Francisco, Department of Neurology, Neurovascular and Neurocritical Care Service, San Francisco, CA, USA
  1. alexander.flint{at}

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A 67-year-old man with diabetes and hypertension developed left-hand weakness. Examination showed plegia of the left hand, including wrist extension and flexion (fig 1, panel D). The sensory examination was normal. Non-contrast head CT showed grey–white blurring of the right “hand knob” motor representation (fig 1, arrow, panel A). CT perfusion showed focal decreased perfusion in the same area (fig 1, arrow, panel B), and diffusion-weighed MRI confirmed local infarction (fig 1, panel C). CT angiogram of the neck showed a right internal carotid artery origin plaque with associated focal stenosis of >70% (fig 1, arrowheads, panel E and inset). Right internal carotid stenting was performed without complications.

Figure 1 (A) Non-contrast head CT showing focal grey–white blurring. (B) CT perfusion showing focal hypoperfusion. (C) Diffusion-weighted MRI showing infarct of the “hand knob”. (D) Patient image demonstrating plegia of the left hand and wrist. (E) CT angiogram of the neck, showing right internal carotid plaque with stenosis in longitudinal and cross-sectional (inset) views.


This article has been adapted from Hall J, Flint A C. “Hand Knob” infarction Journal of Neurology, Neurosurgery and Psychiatry 2008;79:406


  • Patient consent: None.

  • Patient consent: Informed patient consent was obtained for publication of the case details and fig 1.