'Starfish' hand.

摘要

A 57-year-old man with known right carotid occlusion had a right middle cerebral artery stroke involving the caudate head, perisylvian, and temporal-parietal-occipital watershed regions. This caused left arm weakness and gradually severe dystonia emerged in his left hand with spreading of his fingers in a "starfish" pattern (figure, video [www.neurology.org]). One series of botulinum toxin injections was moderately effective. In one study of 1,500 consecutive patients with stroke, 16 developed dystonia. Infarcts in the caudate, putamen, or thalamus are most often associated with acquired hemidystonia likely due to disruption of striatai-thalamic interconnections. Acquired dystonias, including poststroke dystonia, are relatively refractory to medical treatment, although botulinum toxin injections may be effective.