Sirs:Cortical representation of the hand is reported to be located in the knob-like structure of the pre-central gyrus, termed the "precen-tral knob", based on a functional MRI study . Recently, there have been many reports of small cortical infarctions in this precentral knob, causing isolated hand or finger palsy . Isolated shoulder palsy due to a small cortical infarction located medially to precentral knob has also been reported ,We describe a case of unilateral focal shoulder seizure followed by secondary generalization caused by an acute, small cortical infarction in the motor shoulder area.A 61-year-old, right-handed man, a smoker with a history of hypertension and polycythemia vera, suffered partial seizures while resting which were characterized by clonic abduction of the right arm, followed by secondary generalization. He was taken to our hospital by ambulance. On admission, his blood pressure was 149/91 mmHg. There was no convulsion, but he was in a postictal confusion state with incomplete response to verbal commands. He had no paresis suggestive of Todd's paralysis. Tendon reflexes were all normal and plantar responses wereflexor bilaterally. No cranial nerve dysfunction was found. An electrocardiogram showed sinus rhythm. Brain CT detected no abnormal findings. Immediately, phenytoin was administered intravenously.
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