Case 10. Hand spasms
Case
An 85 year old woman presented with a headache and spasms in her left hand, several days after a fall out of bed.
Five nights earlier she had fallen out of bed overnight and hit the right side of her head on a bedside cabinet. She did not lose conscious at the time. She had mild pain in the head localised to the site of impact, but didn't have pain anywhere else, and was able to go back to sleep after this.
Over the next few days she developed an in increasingly severe right-sided headache over a broader area around the temple.
In addition her left hand recurrently would go into what she called a 'spasm'. On further enquiry she reported that the hand would form a claw shape (with fixed, flexed fingers) for several seconds, without pain or sensory symptoms associated (e.g. tingling) - then release. The hand would go limp for a few minutes after this before strength returned. In some of these events she would also have slurred speech, and brief facial drooping after the claw released. Awareness was full throughout these.
In between these periods her hand had normal function.
She took a tablet for high blood pressure but otherwise had no health problems or medications.
Given the ongoing symptoms she presented to the emergency department.
On examination she was alert, fully orientated, and had no neurological abnormalities. No episodes of hand clawing were seen.
Where is the lesion?