• cerebrovascular disease/stroke
• clinical neurology examination
• Partial seizures
• peripheral neuropathy
• pseduo-radial nerve palsy

A 60-year-old man presented with a 5-day history of left-hand weakness and focal seizures. On examination, he had wrist and fingers drop with brisk reflexes in the left upper limb and intact sensation. On asking to firmly clench his fist, there was synkinetic wrist extension and flexion at the elbow joint (online supplementary video 1 and figure 1). MRI brain showed restricted diffusion in the right precentral gyrus, suggestive of ischaemic stroke (figure 2).