Hand knob sign in osmotic demyelinating syndrome
Issued Date
2024-12-01
Resource Type
eISSN
14712377
Scopus ID
2-s2.0-85186400268
Pubmed ID
38429668
Journal Title
BMC Neurology
Volume
24
Issue
1
Rights Holder(s)
SCOPUS
Bibliographic Citation
BMC Neurology Vol.24 No.1 (2024)
Suggested Citation
Siranart N., Nakaphan P., Viarasilpa V., Anukoolwittaya P., Hemachudha P. Hand knob sign in osmotic demyelinating syndrome. BMC Neurology Vol.24 No.1 (2024). doi:10.1186/s12883-024-03584-5 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/97545
Title
Hand knob sign in osmotic demyelinating syndrome
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Abstract
Background: Osmotic demyelinating syndrome, commonly recognized as a consequence of the rapid correction of hyponatremia, has been known to cause motor, neuropsychiatric, or extrapyramidal symptoms. We reported a patient with an unusual presentation involving bilateral hand weakness, and pseudobulbar affect. The imaging was compatible with osmotic demyelinating syndrome with bilateral hand knob lesions, despite no history of overcorrection of hyponatremia. Case presentation: A 44-year-old female presented with three weeks of emotional lability, spastic dysarthria, and bilateral hand weakness following ankle surgery and a mild head injury. Physical examination revealed weakness in the intrinsic hand muscles, leading to a claw-like deformity of the hands, although sensation remained unimpaired. Magnetic resonance imaging (MRI) of the brain revealed several hyperintensities on fluid-attenuated inversion recovery imaging involving various areas, including the hand knob area of the bilateral precentral gyri, caudate, lentiform nuclei, and pons, suggestive of osmotic demyelinating syndrome. Clinical improvement was observed following a trial of intravenous pulse methylprednisolone and plasmapheresis. Conclusions: Bilateral hand weakness is an unusual manifestation of osmotic demyelinating syndrome. The precentral gyrus, specifically in the hand knob area, is the vulnerable region that can result from osmotic demyelinating syndrome.