Fractional arm weakness as presentation of stroke due to posterior borderzone infarct: A report of two cases

A 41-year-old male presented with acute onset weakness of the left hand. Magnetic resonance imaging (MRI) of the brain showed hyperacute infarct in the right middle cerebral artery (MCA)–posterior cerebral artery (PCA) watershed territory. Magnetic resonance angiography (MRA), Doppler ultrasonography, and digital subtraction angiography revealed severe right internal carotid artery (ICA) stenosis. The patient underwent carotid endarterectomy. The second patient was a 48-year-old male with acute onset right wrist drop. MRI of brain showed acute infarct in the left MCA–PCA watershed territory. MRA of brain and neck, Doppler ultrasonography of the neck vessels, and echocardiography were normal. Both the cases were not initially considered strokes by the referring physicians. Isolated hand palsy is a rare presentation of stroke, often mistaken for peripheral lesion. Fractional limb weakness as a presentation of acute ischemic stroke due to borderzone infarction involving parietal lobe is a rarely reported entity.