Table 1.
Demographics, risk factors, type of pseudoperipheral palsy with the clinco-neuroimaging correlates, and outcome
| Case 1 | Case 2 | Case 3 | Case 4 | Case 5 | Case 6 | |
|---|---|---|---|---|---|---|
| Age | 59 years | 47 years | 30 years | 60 years | 35 years | 65 years |
| Gender | Male | Male | Female | Female | Male | Female |
| Time of onset | 1 h after waking up from night sleep | After returning from toilet at 2 am in the night | Early morning could not grasp and pleat her hair | 2 h after waking up from night sleep | 1 h after waking up from night sleep | Early morning while making coffee |
| Duration from onset to admission | 18 h | 24 h | 72 h | 12 h | 48 h | 8 h |
| Pseudoperipheral palsy pattern | Right pseudoradial | Left pseudoradial + ulnar | Left pseudomedian | Left pseudomedian > radial > ulnar | Right pseudoradial | Right pseudomedian |
| Risk factors | Type IIb dyslipidemia, alcohol, smoker, HHcy 18.9 µmol/L | Smoker, alcohol HHcy 12.8 µmol/L CAUS 3.8 cm × 0.5 cm thrombus from mid portion up to bifurcation of right CCA causing 60% 70% luminal stenosis with atheromatous changes |
None Later evolved to left UL motor simple partial seizures HRCT chest and biopsy: 3.8 cm × 3.6 cm medial segment of right lower lobe bronchogenic Adenocarcinoma |
Hypertension Dyslipidemia Forme fruste presentation of new onset left side locked vascular headache of 2 months Left temporal artery biopsy giant cell arteritis |
None Hb: 6.4 g/dl, PCV: 27.8%, and platelets: 450,000/mm3, serum iron: 20 µg/dl Serum ferritin: 68 ng/ml TIBC: 598 4 cm×1 cm left CCA thrombus causing 70% luminal stenosis with atheromatous changes |
Hypertension Type 2 DM Mild exertional intolerance 6 months CXR: Diffuse cardiomegaly ECHO: Dilated cardiomyopathy with; LV dysfunction, LVEF of 45%, mobile thrombus at the basal septum and apical inferior portions of the left |
| Neuroimaging (MRI, MRA, DWI) | Left precentral gyrus + left MCA PCA watershed infarction | Right precentral gyrus infarction (omega sign) | The “culprit” 20 mm enhancing lesion involving right frontal and precentral hand knob area, with multiple “silent” lesions over the right temporal and bilateral cerebellum | Right precentral gyrus infarction (omega sign) | Left MCA PCA watershed infarction | Left precentral gyrus infarction (omega sign) MRA: Focal luminal narrowing in the cavernous segment of the left ICA and the left M1 segment |
| Outcome | Recovered in 2 weeks with anticoagulation therapy | Anticoagulation therapy with complete resolution of carotid thrombus | Died after 4 months of palliative care | Recovered in 2 weeks with pulse methylprednisolone, oral prednisolone, and dual antiplatelet therapy | Recovered within 1 week 2 weeks of enoxaparin; ferric carboxymaltose infusion, iron supplements | Recovered in 2 weeks with enoxaparin Vasodilator, diuretic, and ACEI for DCM |
MRI=Magnetic resonance imaging, MRA=Magnetic resonance angiography, DWI=Diffusion-weighted imaging, MCA=Middle cerebral artery, PCA=Posterior cerebral artery, CAUS=Carotid artery ultrasonography, CCA=Common carotid artery, HRCT=High-resolution computed tomography, Hb=Hemoglobin, PCV=Packed cell volume, TIBC=Total iron-binding capacity, ACEI=Angiotensin-converting enzyme inhibitors, DCM=Dilated cardiomyopathy, LV=Left ventricular, LVEF=LV ejection fraction, DM=Diabetes mellitus, ICA=Internal carotid artery, CXR=Chest X Ray (Chest Skiagram)