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October 06, 2020; 95 (14) Resident & Fellow Section

Teaching NeuroImages: Useless (and restless) hand of Oppenheim in multiple sclerosis

Daniel Ferreira, Daniela Ferro, Guilherme Bastos, Madalena Pinto
First published July 9, 2020, DOI: https://doi.org/10.1212/WNL.0000000000010261
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A 23-year-old man presented a 2-week history of progressive loss of dexterity and incoordination in his right hand together with ipsilateral occipito-cervical paresthesia. In addition, he reported a feeling of discomfort and an urge to move his fingers at rest. Pseudoathetosis (figure 1) and reduced joint position and vibration senses were consistent with the useless hand description of Oppenheim.1

Figure 1
Figure 1 Patient holding the arms outstretched

Pseudoathesosis of the right hand with writhing movements of the fingers exacerbated during eyes closure.

MRI scan was suggestive of multiple sclerosis (MS; figure 2), depicting an active demyelinating lesion in right dorsal cervical spinal cord.

Figure 2
Figure 2 Brain and spinal cord MRI

Axial T2–fluid-attenuated inversion recovery (A) demonstrates multiple demyelinating brain lesions; axial contrast-enhanced T1 (B) and sagittal T2 (C) show an active demyelinating lesion at the C1 level in the posterior spinal cord (arrows).

Restless legs syndrome has been described in MS2 and similar symptomatology can be present in the upper limbs during an MS relapse.

Study funding

No targeted funding reported.

Disclosure

The authors report no disclosures relevant to the manuscript. Go to Neurology.org/Nhttps://n.neurology.org/lookup/doi/10.1212/WNL.0000000000010261 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/B165

References

  1. 1.↵
    1. Oppenheim H
    . Discussion on the different types of multiple sclerosis. Br Med J 1911:729–733.
  2. 2.↵
    1. Manconi M,
    2. Ferini-Strambi L,
    3. Filippi M, et al
    Italian REMS Study Group, Manconi M, Ferini-Strambi L, Filippi M, et al. Multicenter case-control study on restless legs syndrome in multiple sclerosis: the REMS study. Sleep 2008;31:944–952.
    OpenUrlPubMed

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