“Acute Dupuytren’s contracture”: the answer is not always in your hands

A 56-year-old man with prior left hand Dupuytren’s contracture suddenly developed a right hand Dupuytren’s contracture-like posturing ([Figure A]). Bilateral palmar fascial thickening with flexion deformity of the fingers was noted. Neurological examination also disclosed weakness of the right wrist and finger extension, as well as of thumb and index finger abduction. Brain MRI revealed an acute infarction in the left precentral “hand knob” area[1],[2],[3],[4] ([Figure B], [C] and [D]). We emphasize that Dupuytren’s contracture, a supposedly straightforward orthopedic disorder, can be a stroke chameleon. By unbalancing a previous subclinical condition, due to predominant weakness in the extensors, cortical “hand knob” infarction presented as an “acute Dupuytren’s contracture” in this patient.

Figure A) Right hand “acute Dupuytren’s contracture-like posturing” with concomitant prior left Dupuytren’s contracture; B) Axial DWI; C) Axial ADC; D) Axial T2 FLAIR.

• References

• 1 Back T, Mrowka M. Infarction of the “hand knob” area. Neurology. 2001;57(6):1143. https://doi.org/10.1212/WNL.57.6.1143
• 2 Manjaly Z, Luft AR, Sarikaya H. An unusual cause of pseudomedian nerve palsy. Case Rep Neurol Med. 2011;2011:474271. https://doi.org/10.1155/2011/474271
• 3 Alstadhaug KB, Sjulstad A. Isolated hand paresis: a case series. Cerebrovascular Diseases Extra. 2013;3(1):65-73. https://doi.org/10.1159/000350708
• 4 Jusufovic M, Lygren A, Aamodt AH, Nedregaard B, Kerty E. Pseudoperipheral palsy: a case of subcortical infarction imitating peripheral neuropathy. BMC Neurology. 2015;15(1):151. https://doi.org/10.1186/s12883-015-0409-y