PMC3420447_01
(a) Pathological "circle sign" of the right hand. The patient is unable to correctly oppose the tips of digits I and II due to weakness of flexor pollicis longus muscle and the flexor digitorum profundus muscle of the index finger, (b) Luthy's bottle sign. See the gap between the cup and the skin web due to weakness of thumb adduction, opposition, and flexion in median nerve lesion, (c) Normal neurography of the right median nerve, (d) Diffusion-weighted magnetic resonance imaging showing an acute infarction in the "hand knob" area of the left precentral gyrus.
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fig1
Clinical examination of the right hand revealed a moderate paresis (strength 3-4 on the Medical Research Council (MRC) scale for muscle strength) of Mm. flexor digitorum longus et brevis I-III and M. flexor carpi radialis, with prominent impairment of abduction and opposition of the thumb (M3) (Figures 1(a) and 1(b)). Therefore, we subsequently performed a neurography of the right median nerve, which was normal (Figure 1(c)). Magnetic resonance imaging (MRI) on the same day revealed a small diffusion restriction in a part of the left precentral gyrus that is known as "the hand knob" area (Figure 1(d)).