Objective To investigate the risk factors， clinical imaging features， and prognosis of cerebral infarction of the hand knob area of the anterior central gyrus.Methods Clinical data were collected from 12 patients with cerebral infarction of the hand knob area who were admitted from 2015 to 2021.Results The mean age of these patients was 65±11 years. Among these patients， 10 had stroke for the first time， and there were 10 patients with large artery atherosclerosis and 10 with hypertension. As for the TOAST subtype， 6 patients had large artery atherosclerosis subtype， 3 had stroke of undetermined etiology， 2 had cardioembolism， and 1 had stroke of other determined etiology. Atherosclerotic plaques were found in the internal carotid artery （ICA） at the contralateral side in 10 patients. Of all patients， 7 had isolated cerebral infarction in the hand knob area and 5 had multiple acute infarction. There were 8 patients with hand movement disorder alone and 4 patients with hand movement disorder with sensory abnormalities. Of all patients， 10 had an inverted omega （Ω） sign in the hand knob area， and 2 had a horizontal epsilon （ε） sign. Nine patients received antithrombotic therapy with aspirin and statins， and all patients received secondary prevention of cerebrovascular diseases. As for the treatment outcome， 10 patients recovered completely or only had mild hand paralysis， 2 patients showed no significant improvement in symptoms， and 2 patients experienced the recurrence of stroke during follow-up.Conclusions Hypertension and atherosclerosis are common risk factors for cerebral infarction in the hand knob area， and embolism may be an important pathogenesis of this disease. The hand knob area mostly shows an inverted omega （Ω） sign， and isolated hand movement disorder is the main clinical manifestation. Patients with this disease tend to have a good prognosis.