{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T01:00:26Z","timestamp":1783040426348,"version":"3.54.6"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,9,2]],"date-time":"2022-09-02T00:00:00Z","timestamp":1662076800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,9,2]],"date-time":"2022-09-02T00:00:00Z","timestamp":1662076800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Neurol"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Hand knob stroke is a rare clinical disorder frequently misdiagnosed as peripheral neuropathy. The purpose of this study is to recognize this particular type of stroke by analyzing clinical features, etiology, and prognosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We enrolled 19 patients with acute hand knob stroke in the Department of Neurology of the Beijing Geriatric Hospital from January 2018 to January 2022, and the clinical and imaging data of the patients during hospitalization and follow-up were collected and summarized.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Acute hand knob stroke accounted for 0.9% of all acute stroke, and ischemic stroke (17 cases, 89.5%) was more than hemorrhagic stroke (2 cases, 10.5%). All patients presented sudden contralateral hand paresis, 12 (63.2%) of them had only isolated hand paralysis, and the location of the lesion corresponded to different finger weakness. The cause of hand knob hemorrhage was hypertension, while the causes of hand knob infarction were mainly small-vessel occlusion (SVO) (35.3%) and large-artery atherosclerosis (LAA) (35.3%), and the rare causes include carotid artery dissection and carotid body tumor. After a median follow-up 13.5\u2009months, the prognosis of 94.7% patients was good, and one patient (5.3%) had recurrent stroke.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Hand knob stroke is a rare stroke with a good prognosis and a low stroke recurrence rate. Ischemic stroke is the predominant type and the main clinical manifestation is hand paresis. The cause of hand knob hemorrhage is hypertensive, while SVO and LAA are the main causes of hand knob infarction, but there are some rare etiologies.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12883-022-02858-0","type":"journal-article","created":{"date-parts":[[2022,9,2]],"date-time":"2022-09-02T11:22:33Z","timestamp":1662117753000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Clinical features, etiology, and prognosis of hand knob stroke: a case series"],"prefix":"10.1186","volume":"22","author":[{"given":"Zhiyong","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoxin","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinxiu","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,9,2]]},"reference":[{"issue":"Pt 1","key":"2858_CR1","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1093\/brain\/120.1.141","volume":"120","author":"TA Yousry","year":"1997","unstructured":"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\u201357.","journal-title":"Brain"},{"issue":"6","key":"2858_CR2","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1097\/NRL.0b013e31814db093","volume":"13","author":"M Celebisoy","year":"2007","unstructured":"Celebisoy M, Ozdemirkiran T, Tokucoglu F, Kaplangi DN, Arici S. Isolated hand palsy due to cortical infarction: localization of the motor hand area. Neurologist. 2007;13(6):376\u20139.","journal-title":"Neurologist."},{"issue":"11","key":"2858_CR3","doi-asserted-by":"publisher","first-page":"2185","DOI":"10.1212\/WNL.54.11.2185","volume":"54","author":"TG Phan","year":"2000","unstructured":"Phan TG, Evans BA, Huston J. Pseudoulnar palsy from a small infarct of the precentral knob. Neurology. 2000;54(11):2185.","journal-title":"Neurology."},{"issue":"3","key":"2858_CR4","doi-asserted-by":"crossref","first-page":"232470961665831","DOI":"10.1177\/2324709616658310","volume":"4","author":"H Tahir","year":"2016","unstructured":"Tahir H, Daruwalla V, Meisel J, Kodsi SE. Pseudoradial nerve palsy caused by acute ischemic stroke. J Investig Med High Impact Case Rep. 2016;4(3):2324709616658310.","journal-title":"J Investig Med High Impact Case Rep"},{"issue":"6","key":"2858_CR5","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1016\/j.jstrokecerebrovasdis.2003.09.007","volume":"12","author":"J Castaldo","year":"2003","unstructured":"Castaldo J, Rodgers J, Rae-Grant A, Barbour P, Jenny D. Diagnosis and neuroimaging of acute stroke producing distal arm monoparesis. J Stroke Cerebrovasc Dis. 2003;12(6):253\u20138.","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"2858_CR6","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1016\/j.jocn.2019.03.025","volume":"65","author":"AM Finkelsteyn","year":"2019","unstructured":"Finkelsteyn AM, Saucedo MA, Miquelini LA, Chertcoff A, Bandeo L, Pacha S, et al. Ischemic stroke of the \"hand knob area\": a case series and literature review. J Clin Neurosci. 2019;65:100\u20135.","journal-title":"J Clin Neurosci"},{"issue":"7","key":"2858_CR7","doi-asserted-by":"publisher","first-page":"1949","DOI":"10.1016\/j.jstrokecerebrovasdis.2018.02.045","volume":"27","author":"P Orosz","year":"2018","unstructured":"Orosz P, Sz\u0151cs I, Rudas G, Folyovich A, Bereczki D, Vastagh I. Cortical hand knob stroke: report of 25 cases. J Stroke Cerebrovasc Dis. 2018;27(7):1949\u201355.","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"2858_CR8","doi-asserted-by":"crossref","unstructured":"Stroke--1989. Recommendations on stroke prevention, diagnosis, and therapy. Report of the WHO task force on stroke and other cerebrovascular disorders. Stroke. 1989;20(10):1407\u201331.","DOI":"10.1161\/01.STR.20.10.1407"},{"issue":"1","key":"2858_CR9","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1161\/01.STR.24.1.35","volume":"24","author":"HP Adams Jr","year":"1993","unstructured":"Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of org 10172 in acute stroke treatment. Stroke. 1993;24(1):35\u201341.","journal-title":"Stroke."},{"issue":"7","key":"2858_CR10","doi-asserted-by":"publisher","first-page":"1146","DOI":"10.1007\/s00415-009-5104-8","volume":"256","author":"N Peters","year":"2009","unstructured":"Peters N, M\u00fcller-Schunk S, Freilinger T, D\u00fcring M, Pfefferkorn T, Dichgans M. Ischemic stroke of the cortical \"hand knob\" area: stroke mechanisms and prognosis. J Neurol. 2009;256(7):1146\u201351.","journal-title":"J Neurol"},{"issue":"5","key":"2858_CR11","doi-asserted-by":"publisher","first-page":"857","DOI":"10.1007\/s10072-018-3278-5","volume":"39","author":"Y Wang","year":"2018","unstructured":"Wang Y, Dong Q, Li SJ, Hu WL. New clinical characteristics and risk factors of hand knob infarction. Neurol Sci. 2018;39(5):857\u201362.","journal-title":"Neurol Sci"},{"issue":"6","key":"2858_CR12","doi-asserted-by":"publisher","first-page":"520","DOI":"10.1136\/practneurol-2018-001971","volume":"18","author":"F Brigo","year":"2018","unstructured":"Brigo F, Ragnedda G, Canu P, Nardone R. Synkinetic wrist extension in distinguishing cortical hand from radial nerve palsy. Pract Neurol. 2018;18(6):520\u20131.","journal-title":"Pract Neurol"},{"issue":"12","key":"2858_CR13","doi-asserted-by":"publisher","first-page":"1677","DOI":"10.1212\/WNL.56.12.1677","volume":"56","author":"JS Kim","year":"2001","unstructured":"Kim JS. Predominant involvement of a particular group of fingers due to small, cortical infarction. Neurology. 2001;56(12):1677\u201382.","journal-title":"Neurology."},{"issue":"10","key":"2858_CR14","doi-asserted-by":"publisher","first-page":"1877","DOI":"10.1007\/s10072-017-2997-3","volume":"38","author":"FC de Medeiros","year":"2017","unstructured":"de Medeiros FC, Viana DCR, Cunha MN, Hatasa CC, Ara\u00fajo RV. Pure motor monoparesis due to infarction of the \"hand knob\" area: radiological and morphological features. Neurol Sci. 2017;38(10):1877\u20139.","journal-title":"Neurol Sci"},{"issue":"9","key":"2858_CR15","doi-asserted-by":"publisher","first-page":"1589","DOI":"10.1212\/WNL.57.9.1589","volume":"57","author":"A Gass","year":"2001","unstructured":"Gass A, Szabo K, Behrens S, Rossmanith C, Hennerici M. A diffusion-weighted MRI study of acute ischemic distal arm paresis. Neurology. 2001;57(9):1589\u201394.","journal-title":"Neurology."},{"issue":"3","key":"2858_CR16","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1159\/000016061","volume":"10","author":"A Arboix","year":"2000","unstructured":"Arboix A, Garc\u00eda-Eroles L, Massons J, Oliveres M, Targa C. Hemorrhagic lacunar stroke. Cerebrovasc Dis. 2000;10(3):229\u201334.","journal-title":"Cerebrovasc Dis"},{"issue":"1","key":"2858_CR17","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1159\/000350708","volume":"3","author":"KB Alstadhaug","year":"2013","unstructured":"Alstadhaug KB, Sjulstad A. Isolated hand paresis: a case series. Cerebrovasc Dis Extra. 2013;3(1):65\u201373.","journal-title":"Cerebrovasc Dis Extra"},{"issue":"5","key":"2858_CR18","doi-asserted-by":"crossref","first-page":"688","DOI":"10.4103\/aian.AIAN_9_19","volume":"23","author":"BP Shelley","year":"2020","unstructured":"Shelley BP, Harishchandra P, Devadas AK. Selective hand motor cortex lesions masquerading as \"Pseudoperipheral nerve palsy\". Ann Indian Acad Neurol. 2020;23(5):688\u201393.","journal-title":"Ann Indian Acad Neurol"},{"issue":"42","key":"2858_CR19","doi-asserted-by":"publisher","first-page":"E1164","DOI":"10.1503\/cmaj.190673","volume":"191","author":"Y Tomoda","year":"2019","unstructured":"Tomoda Y, Tanaka M, Tanaka K. Hand knob stroke from cancer-associated thromboembolism. CMAJ. 2019;191(42):E1164.","journal-title":"CMAJ."},{"issue":"8","key":"2858_CR20","doi-asserted-by":"publisher","first-page":"822","DOI":"10.1016\/S1474-4422(13)70124-8","volume":"12","author":"JM Wardlaw","year":"2013","unstructured":"Wardlaw JM, Smith EE, Biessels GJ, Cordonnier C, Fazekas F, Frayne R, et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol. 2013;12(8):822\u201338.","journal-title":"Lancet Neurol"},{"issue":"7","key":"2858_CR21","first-page":"e9024","volume":"12","author":"H Kesserwani","year":"2020","unstructured":"Kesserwani H. Ischemic infarct of the hand knob gyrus: natural history, morphology, and localizing value of the omega sulcus - a case report with a side note on the dynamic forces underlying sulci formation. Cureus. 2020;12(7):e9024.","journal-title":"Cureus."},{"issue":"2","key":"2858_CR22","doi-asserted-by":"publisher","first-page":"396","DOI":"10.1016\/j.cell.2020.02.043","volume":"181","author":"FR Willett","year":"2020","unstructured":"Willett FR, Deo DR, Avansino DT, Rezaii P, Hochberg LR, Henderson JM, et al. Hand knob area of premotor cortex represents the whole body in a compositional way. Cell. 2020;181(2):396\u2013409.e26.","journal-title":"Cell."}],"container-title":["BMC Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12883-022-02858-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12883-022-02858-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12883-022-02858-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,26]],"date-time":"2023-11-26T14:18:11Z","timestamp":1701008291000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcneurol.biomedcentral.com\/articles\/10.1186\/s12883-022-02858-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,2]]},"references-count":22,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["2858"],"URL":"https:\/\/doi.org\/10.1186\/s12883-022-02858-0","relation":{},"ISSN":["1471-2377"],"issn-type":[{"value":"1471-2377","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,2]]},"assertion":[{"value":"11 July 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 August 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 September 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was conducted following the 1964 Declaration of Helsinki and its later amendments and was approved by the institutional review board of Beijing Geriatric Hospital. All patients provided written informed consent prior to their inclusion in the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"331"}}