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March 12, 2019; 92 (11) Resident & Fellow Section

Teaching Video NeuroImages: Stroke presenting with isolated toe-spreading palsy

Teruhiko Sekiguchi, Toshiro Kanazawa, Hiroaki Tanaka
First published March 11, 2019, DOI: https://doi.org/10.1212/WNL.0000000000007102
Teruhiko Sekiguchi
From the Department of Neurology, Yokohama City Minato Red Cross Hospital, Japan.
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Toshiro Kanazawa
From the Department of Neurology, Yokohama City Minato Red Cross Hospital, Japan.
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Hiroaki Tanaka
From the Department of Neurology, Yokohama City Minato Red Cross Hospital, Japan.
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Teaching Video NeuroImages: Stroke presenting with isolated toe-spreading palsy
Teruhiko Sekiguchi, Toshiro Kanazawa, Hiroaki Tanaka
Neurology Mar 2019, 92 (11) e1268-e1269; DOI: 10.1212/WNL.0000000000007102

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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).

Figure 1
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Figure 1 Motions of the patient's toes

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

Figure 2
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Figure 2 The patient's brain MRI

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

Table1

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

References

  1. 1.↵
    1. Hiraga A
    . Pure motor monoparesis due to ischemic stroke. Neurologist 2011;17:301–308.
    OpenUrlPubMed
  2. 2.↵
    1. Schieber MH
    . Constraints on somatotopic organization in the primary motor cortex. J Neurophysiol 2001;86:2125–2143.
    OpenUrlPubMed
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