Dysarthria-clumsy hand syndrome: The mystery of internal capsule anatomy

Lacunar acute ischemic stroke is a common neurological emergency worldwide. The clinical presentation varies widely depending upon the location of the stroke. Dysarthria-clumsy hand syndrome is a distinct clinical entity which is characterized by difficulty speaking due to weakness of the muscles of articulation and/or phonation and clumsiness in the upper extremity without significant weakness. It is classically described in lacunar strokes involving the splenium/genu of internal capsule or basis pontis. It is rarely reported in strokes involving the other areas of brain. We report a case of dysarthria-clumsy hand syndrome in a patient who developed lacunar acute ischemic stroke in the posterior aspect of the posterior limb of right internal capsule. He was also found out to have coarctation of the descending thoracic aorta, ectasia of the ascending aorta and an aneurysm in the left middle cerebral artery at its bifurcation. The significance of these coexisting vascular anomalies is unknown.