LESIONS

A Guide to Localisation in Neurology

Case 2. Clumsy hand

Case

An 18 year old man noted clumsiness in his dominant right hand.

He usually had great coordination, including playing darts, but was now finding it harder to use the hand – including to pick up cutlery and hold items, or write neatly. He had become aware of this one day and in the following 5 days it was becoming more prominent. His hand felt strange – not weak or numb, just not under his normal level of control. He otherwise felt well, with no other symptoms, including no headache or neck pain, and no issues in other limbs or with gait, balance, and bladder function.

He had no past medical history and led an active, healthy lifestyle. He did not drink alcohol or use drugs.

On examination, he had:

• Right arm dysmetria and intention tremor on finger-nose testing
• Right arm dysdiadochokinesia when alternately tapping with the palm and dorsal hand - compared to the left arm which had normal coordination

There was no abnormality on heel-shin testing in the legs.

He had normal cranial nerves (including eye movements and speech), tone, power, reflexes, sensation (all modalities) in all 4 limbs, gait (including tandem), and Romberg’s sign was absent.