PSEUDORADIAL NERVE PALSY: A RARE PRESENTATION OF ACUTE STROKE DEFERRING THE DIAGNOSIS AND DEPRIVING OF THE TREATMENT

Pseudoperipheral nerve palsy has been used to describe sudden isolated focal weakness of a group of limb muscles secondary to stroke. Pseudoradial nerve palsy is a rare presenting feature for acute stroke. Our case 64 years hypertensive male noticed sudden weakness of dorsiflexion of left wrist following a minor road traffic accident. After examination a working diagnosis of traumatic acute left radial nerve palsy or cervical radiculopathy were made. Xray of his left upper limb and cervical spine were normal. Cervical MRI was also noncontributory. NCS of upper limb even after ten days were normal. Then we did MRI of brain which revealed acute ischemic stroke involving right parietal cortex adjuscent to central sulcus as the cause of his wrist drop. He was put on DAP and investigated for cause of stroke. However, after three months power remained grade 3/5. Had the stroke been diagnosed at presentation, patient could have been thrombolysed and he may have recovered completely. We review the literature and discuss the case with probable differential diagnosis at presentation. In conclusion, we emphasize the need for high level of suspicion for diagnosis of acute stroke in patients of stroke-age group with one or multiple risk factors who present with atypical features like pseudmononeuropathy or pseudoradial neuropathy, specially when the etiology is not evident.