E-Pearl of the Week: Unilateral Clubbing in Hemiplegia

May 9, 2012

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Brought to you by the Resident and Fellow Section of Neurology®.

May 8, 2012

Unilateral Clubbing in Hemiplegia

Nail pathology is well described in systemic and central nervous system disorders. Patients with chronic hemiplegia can develop unilateral decrease in nail growth rate, dyschromic changes, and increases in nail plate convexity leading to fingernail clubbing. Nail clubbing, a beaked fingertip deformity, occurs because of hyperplasia of dermal fibrovascular tissue. Advanced clubbing involves bony destruction of the distal phalanges with osteoblast proliferation. Bilateral symmetric clubbing is classically seen in congenital heart disease and chronic pulmonary disease. Unilateral clubbing exclusively occurring because of hemiplegia is rare, only affecting about 2% of hemiplegic patients, and may result from local autonomic dysregulation.

Reference

1. Velur P, Kalamangalam GP. Unilateral Clubbing in Hemiplegia. Neurology 2012; 78: e122.
2. Siragusa M, Schepis C, Cosentino FII, Spada RS, Toscano G, Ferri R. Nail pathology in patients with hemiplegia. Br J Dermatol 2001; 144:557-560.

Submitted by: Jennifer E. Fugate, DO

Disclosure: Dr. Fugate serves on the editorial team for the Neurology Resident and Fellow Section.

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