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
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.
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
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Footnotes
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Teaching slides links.lww.com/WNL/B165
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