A 75-year-old man suddenly could not keep his slipper on the right foot and consulted our hospital. He could dorsiflex and plantarflex his toes (figure 1, A–C, videos 1 and 2) and ankles, but could not spread his right toes (figure 1D, video 3). MRI revealed acute infarction in the left precentral gyrus (figure 2).
The patient's feet at rest (A) and after commands to dorsiflex (B), plantarflex (C), and spread (D) his toes.
Video 1
Patient was asked to dorsiflex all toes.Download Supplementary Video 1 via http://dx.doi.org/10.1212/007102_Video_1
Video 2
Patient was asked to plantarflex all toes.Download Supplementary Video 2 via http://dx.doi.org/10.1212/007102_Video_2
Video 3
Patient was asked to spread all toes.Download Supplementary Video 3 via http://dx.doi.org/10.1212/007102_Video_3
Axial (A), sagittal (B), and coronal (C) sections of diffusion-weighted images and axial sections (D–F) of fluid-attenuated inversion recovery. Arrows: central sulcus.
Contralateral pure motor monoparesis after cortical infarction in the precentral gyrus results in paresis of multiple motions in a single extremity.1 However, our patient's palsy was limited to toe-spreading, elucidating the specific topography of toe movements in primary motor cortex, though if such somatotopy exists, it is controversial.2
Study funding
No targeted funding reported.
Disclosure
The authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.
Appendix Authors
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Teaching slides links.lww.com/WNL/A831
- © 2019 American Academy of Neurology
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