{
  "abstract": "A woman in her mid-70s presented to the emergency department with a 2-day history of right-hand clumsiness. Her medical history included well-controlled diabetes, hypertension and dyslipidaemia. She was taking manidipine and rosuvastatin. On presentation, she was alert and oriented. Vital signs included a blood pressure of 145/74 mm Hg and a heart rate of 66 beats per minute. Cardiac auscultation revealed no murmurs, and peripheral pulses were symmetric. A brief neurological examination revealed an excavated appearance of the right palm during the pronator drift test, although neither pronation nor drift of the right arm was observed ( figure 1A). Extraocular movements and facial strength were normal, and no dysarthria was present. The Mingazzini test was unremarkable. The emergency physician initially suspected a stroke, but a head MRI ruled out this possibility.",
  "authors": [
    {
      "affiliations": [
        "Department of Rheumatology, Suwa Central Hospital, Chino, Nagano, Japan"
      ],
      "name": "Hiroshi Shiba"
    },
    {
      "affiliations": [
        "Department of Neurology, Gifu University Graduate School of Medicine, Gifu, Gifu, Japan"
      ],
      "name": "Yasushi Shiba"
    },
    {
      "affiliations": [
        "Department of Neurology, Suwa Central Hospital, Chino, Nagano, Japan"
      ],
      "name": "Keisuke Watanabe"
    },
    {
      "affiliations": [
        "Diagnostic and Generalist Medicine, Dokkyo Medical University, Shimotsuga, Tochigi, Japan"
      ],
      "name": "Taro Shimizu"
    }
  ],
  "title": "Misinterpreted pyramidal sign: revisiting Garcin’s description of the hollow hand sign",
  "uid": "f54521a3-8f8a-52b9-863b-2abd381d073a"
}