Shoulder Palsy due to Middle Cerebral Artery Embolism

Hiromasa Tsuda, Sayaka Nagao, Yuto Yamazaki, Kozue Tanaka


An 80-year-old Japanese woman with paroxysmal atrial fibrillation suddenly developed sensory aphasia, with moderate weakness restricted to the right shoulder with normal muscle strength in the elbow, wrist and fingers. There were no other neurological abnormalities. Diffusion-weighted cranial magnetic resonance imaging demonstrated scattered infarct lesions in the territory of the left middle cerebral artery (MCA), probably due to cardiogenic embolism. Right-sided shoulder palsy might have been caused by a localized infarct lesion in the precentral gyrus on the left side, and resolved within 10 days. Because the area corresponding to the shoulder is small in the primary motor cortex, isolated shoulder palsy due to cortical infarction is very rare. Its etiology remains controversial, but borderzone ischemia between the anterior cerebral artery and MCA, and atherothrombosis of the cortical branch of MCA are proposed. Our case shows that the area corresponding to the shoulder receives blood from the cortical branch of MCA.

J Med Cases. 2013;4(2):86-88


Aphasia; Atrial fibrillation; Homunculus; Precentral gyrus; Primary motor cortex

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