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Russo M, Carrarini C, Dono F, Di Stefano V, De Angelis MV, Onofrj M, Sensi SL. Posterior Variant of Alien Limb Syndrome with Sudden Clinical Onset as Self-Hitting Associated with Thalamic Stroke. Case Rep Neurol 2020; 12:35-39. [PMID: 32095130 PMCID: PMC7011710 DOI: 10.1159/000503857] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 10/01/2019] [Indexed: 11/23/2022] Open
Abstract
We present a case of sudden postischaemic onset of alien limb syndrome, with unintentional self-injury. Alien limb syndrome is an uncommon neurological disorder featured by uncontrolled and involuntary movements of a limb. Three variants of alien limb syndrome have been described: the anterior, featured by grasping of surrounding objects, the callosal, presenting with intermanual conflict, and the posterior, associated with involuntary levitation of the limb. Our patient suffered from an acute presentation of the posterior variant of the alien limb syndrome, resulting from an isolated thalamic stroke which was documented using 24-h computed tomography brain scan. Only one previous case of alien limb syndrome after thalamic infarct has been reported. Our case enhances the possibility that pure thalamic injury may represent a trigger for this condition.
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Affiliation(s)
- Mirella Russo
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Claudia Carrarini
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Fedele Dono
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Vincenzo Di Stefano
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Maria Vittoria De Angelis
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Marco Onofrj
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Stefano L Sensi
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.,Behavioral Neurology and Molecular Neurology Units, Center of Excellence on Aging and Translational Medicine - CeSI-MeT, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.,Departments of Neurology and Pharmacology, Institute for Mind Impairments and Neurological Disorders - iMIND, University of California, Irvine, California, USA
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Abstract
Alien hand syndrome (AHS) is a rare disorder of involuntary limb movement together with a sense of loss of limb ownership. It most commonly affects the hand, but can occur in the leg. The anterior (frontal, callosal) and posterior variants are recognized, with distinguishing clinical features and anatomical lesions. Initial descriptions were attributed to stroke and neurosurgical operations, but neurodegenerative causes are now recognized as most common. Structural and functional imaging and clinical studies have implicated the supplementary motor area, pre-supplementary motor area, and their network connections in the frontal variant of AHS, and the inferior parietal lobule and connections in the posterior variant. Several theories are proposed to explain the pathophysiology. Herein, we review the literature to update advances in the understanding of the classification, pathophysiology, etiology, and treatment of AHS.
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Affiliation(s)
- Anhar Hassan
- Department of Neurology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Keith A Josephs
- Department of Neurology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
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3
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Scepkowski LA, Cronin-Golomb A. The Alien Hand: Cases, Categorizations, and Anatomical Correlates. ACTA ACUST UNITED AC 2016; 2:261-77. [PMID: 15006289 DOI: 10.1177/1534582303260119] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The clinical characteristics and neuroanatomical damage reported in more than 50 published cases of observed “alien-hand” signs are reviewed. The terms alien-hand sign and alien-hand syndrome describe phenomena experienced by patients in which an upper limb performs complex motor activities outside of volitional control. The categories of frontal and callosal subtypes and their relation to behavior and neuropathology are evaluated with reference to the dual premotor system theory, which emphasizes the role of the supplementary motor areas in alien-hand phenomena. Detailed consideration is given to the more recently described posterior subtype, which is purported to result from damage to the parietal lobe or other posterior brain areas. The lack of uniformity in reported assessment methods (behavioral tests, neuroimaging) in published cases contributes to the difficulty in establishing clear subtypes of alien-hand phenomena. Suggestions are made regarding current categorizations and available assessment methods.
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Sarva H, Deik A, Severt WL. Pathophysiology and treatment of alien hand syndrome. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2014; 4:241. [PMID: 25506043 PMCID: PMC4261226 DOI: 10.7916/d8vx0f48] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 10/21/2014] [Indexed: 12/01/2022]
Abstract
Background Alien hand syndrome (AHS) is a disorder of involuntary, yet purposeful,
hand movements that may be accompanied by agnosia, aphasia, weakness, or sensory
loss. We herein review the most reported cases, current understanding of the
pathophysiology, and treatments. Methods We performed a PubMed search in July of 2014 using the phrases “alien hand
syndrome,” “alien hand syndrome pathophysiology,” “alien
hand syndrome treatment,” and “anarchic hand syndrome.” The
search yielded 141 papers (reviews, case reports, case series, and clinical
studies), of which we reviewed 109. Non-English reports without
English abstracts were excluded. Results Accumulating evidence indicates that there are three AHS variants: frontal,
callosal, and posterior. Patients may demonstrate symptoms of multiple types;
there is a lack of correlation between phenomenology and neuroimaging findings.
Most pathologic and functional imaging studies suggest network disruption causing
loss of inhibition as the likely cause. Successful interventions include botulinum
toxin injections, clonazepam, visuospatial coaching techniques, distracting the
affected hand, and cognitive behavioral therapy. Discussion The available literature suggests that overlap between AHS subtypes is common. The
evidence for effective treatments remains anecdotal, and, given the rarity of AHS,
the possibility of performing randomized, placebo-controlled trials seems
unlikely. As with many other interventions for movement disorders, identifying the
specific functional impairments caused by AHS may provide the best guidance
towards individualized supportive care.
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Affiliation(s)
- Harini Sarva
- Department of Neurology, Maimonides Medical Center, New York, NY, USA
| | - Andres Deik
- Parkinson Disease and Movement Disorders Center, Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
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Kamogawa K, Ninomiya S, Okuda S, Matsumoto Y, Tomita H, Okamoto K, Okuda B. [A case of Creutzfeldt-Jakob disease presenting with arm levitation as an initial symptom]. Rinsho Shinkeigaku 2014; 54:803-8. [PMID: 25342014 DOI: 10.5692/clinicalneurol.54.803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 74-year-old, right handed man, developed insidiously with levitation and clumsiness of the right upper limb. His right arm tended to levitate spontaneously, when he was examined. He could put the elevated arm down on command, while the arm resumed to antigravity posture when his attention was diverted. His right arm also exhibited unwilled elevation when performing complex finger movements on the right side. He had a feeling of strangeness of the elevated limb, especially with the eyes closed. In addition to asymmetric limb-kinetic apraxia, combined sensations such as stereognosis were disturbed on the right side. Brain MRI showed high signal lesions predominantly in the left cerebral cortices and basal ganglia. SPECT with (123)I-IMP revealed asymmetric hypoperfusion, predominantly in the left medial frontal and parietal regions. Two months after the onset, levitation of the arm gradually disappeared, with the development of rapidly progressive dementia, frontal signs, dystonia and generalized myoclonus. The diagnosis of Creutzfeldt-Jakob disease (CJD) was made based on the clinical features and cerebrospinal fluid biomarkers. The early manifestation of the patient mimicked corticobasal degeneration which presents with arm levitation or alien hand syndrome. It is suggested that CJD can represent involuntary movements with higher brain dysfunction resembling corticobasal degeneration at the early stage of the illness. Although the underlying mechanism of arm levitation is still unknown, frontal disinhibition and parietal cortical sensory disturbance may contribute to the development of involuntary arm levitation in our patient.
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Affiliation(s)
- Kenji Kamogawa
- Department of Neurology, Ehime Prefectural Central Hospital
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Bakheit AMO, Brennan A, Gan P, Green H, Roberts S. Anarchic hand syndrome following resection of a frontal lobe tumor. Neurocase 2013; 19:36-40. [PMID: 22494197 DOI: 10.1080/13554794.2011.654213] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Anarchic hand syndrome (AHS) is a rare disorder characterized by unwilled, but seemingly purposeful movements of the affected upper limb which are perceived by the patients not to be under their control. It often interferes with goal-directed movements and bimanual tasks. At present there is no effective method of treatment of AHS. We report here a case of AHS following resection of a frontal lobe tumor and describe its effects on the patient's functional activities. The patient used avoidance behavior and mental concentration to overcome the disabling effect of AHS. These strategies appear to be useful in the management of AHS.
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Affiliation(s)
- A M O Bakheit
- Moseley Hall Hospital, Alcester Road, Birmingham, UK.
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Bartolo M, Zucchella C, Pichiecchio A, Pucci E, Sandrini G, Sinforiani E. Alien hand syndrome in left posterior stroke. Neurol Sci 2011; 32:483-6. [DOI: 10.1007/s10072-011-0490-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Accepted: 01/31/2011] [Indexed: 11/25/2022]
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Kloesel B, Czarnecki K, Muir JJ, Keller AS. Sequelae of a left-sided parietal stroke: posterior alien hand syndrome. Neurocase 2010; 16:488-93. [PMID: 20824573 DOI: 10.1080/13554794.2010.497154] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Posterior alien hand syndrome is a new addition to a poorly understood group of movement disorders. Historically, anatomical lesions causing uncontrolled limb movement and a feeling of foreignness were found to be located in the corpus callosum or frontal lobe. Recent case reports, however, demonstrate the typical symptoms of alien hand syndrome with lesions located in the parietal/occipital lobes. Disturbance of normal function in these regions tends to produce less complex motor activity, such as hand levitation, along with a sensory component characterized by feeling of estrangement. We discuss a patient who presented with unusual symptoms following an outpatient procedure and was found to have posterior alien hand syndrome.
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Affiliation(s)
- Benjamin Kloesel
- Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
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Takenouchi T, Solomon GE. Alien hand syndrome in Parry-Romberg syndrome. Pediatr Neurol 2010; 42:280-2. [PMID: 20304333 DOI: 10.1016/j.pediatrneurol.2009.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Revised: 10/12/2009] [Accepted: 11/09/2009] [Indexed: 11/25/2022]
Abstract
A pediatric patient with diagnosis of Parry-Romberg syndrome, or progressive hemifacial atrophy, presented with new-onset unilateral alien hand syndrome, which was attributed to focal progressive atrophy and gliosis in the contralateral thalamus observed on serial neuroimaging. This case illustrates not only the clinical-radiographic correlation between alien hand syndrome and contralateral thalamic lesion, but also involvement of deep gray structure in Parry-Romberg syndrome causing a rare movement disorder.
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Affiliation(s)
- Toshiki Takenouchi
- Division of Pediatric Neurology, Department of Pediatrics, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York 10021, USA.
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Kessler J, Hathout G. Dominant posterior-variant alien hand syndrome after acute left parietal infarction. Clin Neurol Neurosurg 2009; 111:633-5. [DOI: 10.1016/j.clineuro.2009.05.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Revised: 05/07/2009] [Accepted: 05/11/2009] [Indexed: 11/15/2022]
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Hashimoto M, Shimizu J, Shirota Y, Momose Y, Goto J, Takeda K, Tsuji S. [Alien hand sign observed at the initial stage of a case of Creutzfeldt-Jakob disease]. Rinsho Shinkeigaku 2009; 49:109-14. [PMID: 19348176 DOI: 10.5692/clinicalneurol.49.109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 68-year-old man was admitted to our hospital in the mid-October of 2006 because of a one-month history of peculiar movements of the left hand, which had been preceded by one month by awkward motions in the left leg. Upon neurological examination, spontaneous involuntary movement of the left hand was found. His left hand with his index finger stretched moved toward his right side spontaneously. He could not control his left leg freely. Although he showed mild ataxia in his left hand, there was no weakness, no dystonia, and no apraxia. No sensory abnormality was detected except for mild deep-sensation impairment in his left foot. The results of magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI) were normal; however, single-photon emission computed tomography (SPECT) showed hypoperfusion in the right hemisphere. At the time of admission, although a clinical diagnosis could not be made, we considered that the involuntary movements of his left hand were consistent with alien hand sign (AHS). Two and a half months after its onset, with the development of rapidly progressive dementia and generalized myoclonus, AHS gradually disappeared. Three months after the AHS onset, MRI with DWI showed restricted diffusion within the cortex involving the cingulated gyrus and bilateral temporal lobes, which was more prominent on the right than on the left side. Four months after the AHS onset, 14-3-3 protein level of the cerebrospinal fluid was elevated, and EEG recordings showed diffuse slowing of basic activity with periodic complexes. The patient was clinically diagnosed as having CJD. The patient died of pneumonia four and a half months after the AHS onset. AHS has rarely been reported in patients with CJD. Our case illustrates the importance of considering CJD in the differential diagnosis, if the patient showed AHS, even with normal MRI findings.
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Affiliation(s)
- Meiko Hashimoto
- Department of Neurology, University of Tokyo, Graduate School of Medicine
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12
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Caixeta L, Maciel P, Nunes J, Nazareno L, Araújo L, Borges JR. Alien hand syndrome in AIDS: Neuropsychological features and physiopathological considerations based on a case report. Dement Neuropsychol 2007; 1:418-421. [PMID: 29213422 PMCID: PMC5619440 DOI: 10.1590/s1980-57642008dn10400016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Alien hand syndrome consists of an autonomous motor activity perceived as an
involuntary yet purposeful movement, with a feeling of foreignness of the
involved limb, commonly associated with a failure to recognize ownership of the
limb in the absence of visual cues. A 41 year old left-handed woman, HIV
positive, evolved with loss of control in the left hand. Her left hand presented
extravolitional movements, as if having a will of its own, not responding to
commands such as opening a door or holding an umbrella, but instead groping
unneeded objects. She had talked to her hand and even fought it. In addition,
other clinical presentations including recent memory loss, hemineglect and
dysphoria were observed. Computed tomography revealed a hypodensity area in the
right frontal-parietal region, with midline deviation. Considering clinical and
epidemiological data, the diagnosis of Central Nervous System (CNS)
toxoplasmosis was reached. No previous reports showing association among AIDS,
toxoplasmosis and alien hand syndrome were found.
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Affiliation(s)
- Leonardo Caixeta
- Adjunct Professor. Behavioral Neurology Unit, Hospital das Clínicas, Federal University of Goiás, Brazil
| | - Patrícia Maciel
- collaborating physician. Behavioral Neurology Unit, Hospital das Clínicas, Federal University of Goiás, Brazil
| | - Juliana Nunes
- collaborating physician. Behavioral Neurology Unit, Hospital das Clínicas, Federal University of Goiás, Brazil
| | - Larissa Nazareno
- collaborating physician. Behavioral Neurology Unit, Hospital das Clínicas, Federal University of Goiás, Brazil
| | - Letícia Araújo
- collaborating physician. Behavioral Neurology Unit, Hospital das Clínicas, Federal University of Goiás, Brazil
| | - Jules Rimet Borges
- collaborating physician. Behavioral Neurology Unit, Hospital das Clínicas, Federal University of Goiás, Brazil
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Coulthard E, Rudd A, Playford ED, Husain M. Alien limb following posterior cerebral artery stroke: Failure to recognize internally generated movements? Mov Disord 2007; 22:1498-1502. [PMID: 17516456 DOI: 10.1002/mds.21546] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We describe two rare cases of alien limb syndrome following right posterior cerebral artery (PCA) stroke. Both patients present with left hemianopia, visual neglect and proprioceptive loss in addition to their alien limb symptoms. Lesion subtraction from seven control PCA patients revealed that medial parietal-occipital and thalamic areas were selectively damaged in the alien limb patients. We propose that loss of the sense of motor intention and internal model of the current state of the arm, combined with deficient proprioceptive and visual feedback of the moving limb, are critical for genesis of posterior alien limb and discuss how affected regions normally function to ensure awareness of self-generated motor activity.
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Affiliation(s)
- Elizabeth Coulthard
- Institute of Neurology, University College London, London, United Kingdom
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
| | - Anthony Rudd
- St Thomas' Hospital, London, United Kingdom
- King's College, London, United Kingdom
| | - E Diane Playford
- Rehabilitation Group, Institute of Neurology, London, United Kingdom
| | - Musad Husain
- Institute of Neurology, University College London, London, United Kingdom
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
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Keenan JP, Gorman J. The Causal Role of the Right Hemisphere in Self-Awareness: It is the Brain that is Selective. Cortex 2007. [DOI: 10.1016/s0010-9452(08)70705-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Biran I, Giovannetti T, Buxbaum L, Chatterjee A. The alien hand syndrome: What makes the alien hand alien? Cogn Neuropsychol 2006; 23:563-82. [DOI: 10.1080/02643290500180282] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kikkert MA, Ribbers GM, Koudstaal PJ. Alien Hand Syndrome in Stroke: A Report of 2 Cases and Review of the Literature. Arch Phys Med Rehabil 2006; 87:728-32. [PMID: 16635638 DOI: 10.1016/j.apmr.2006.02.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Alien hand syndrome (AHS) is a rare condition that occurs in patients with brain injury. It has also been described in stroke subjects, after callosotomy, and in corticobasal degeneration. The common feature of AHS is the involuntary autonomous activity of the affected extremity that is perceived as being controlled by an external force. AHS as a nosologic entity has been challenged. A complex variety of abnormal involuntary motor behaviors may follow cerebral lesions in different cerebral locations such as the corpus callosum, the parietal, or frontal regions. Although different subtypes of AHS have been distinguished, this classification clearly does not cover the wide clinical variety of abnormal (involuntary) motor behaviors of the upper extremity. In this report, we provide a review of literature on abnormal involuntary motor behaviors of the upper extremity after a stroke, which may help to improve early recognition of AHS and facilitate adjustment of rehabilitation therapy. Furthermore, we briefly discuss the complex variety of abnormal, involuntary motor behaviors that may follow after cerebral lesions, their anatomic substrates, the underlying mechanisms, and the prognosis.
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17
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Kritikos A, Breen N, Mattingley JB. Anarchic hand syndrome: Bimanual coordination and sensitivity to irrelevant information in unimanual reaches. ACTA ACUST UNITED AC 2005; 24:634-47. [PMID: 15921901 DOI: 10.1016/j.cogbrainres.2005.03.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2004] [Revised: 03/15/2005] [Accepted: 03/16/2005] [Indexed: 11/20/2022]
Abstract
Anarchic hand syndrome is characterised by unintended but purposeful and autonomous movements of the upper limb and intermanual conflict. Based on predictions of internal models of movement generation, we examined the role of visual cues in unimanual and bimanual movements in a patient with anarchic hand syndrome and in a matched control. In Experiment 1, participants made unimanual movements in a sequential button-pressing task. The cue for the next target in a sequence appeared either prior to (exogenous) or after (endogenous) the initiation of movement. For the patient, performance of the anarchic left hand was selectively impaired in the endogenous condition. In Experiment 2, participants made unimanual movements on a digitising tablet to a target, which appeared either alone or with a distractor. While the presence of a distractor was associated with increased Initiation time in general, the patient's anarchic left hand was particularly vulnerable to disruption by the distractor. The findings of Experiments 1 and 2 indicate excessive reliance on salient environmental stimuli for movement production in anarchic hand syndrome. We conclude that in AHS goal-directed actions of the affected limb are particularly vulnerable to disruption by non-relevant information. Finally, in Experiment 3, participants performed unimanual and mirror-image bimanual movements on a digitising tablet to targets in the left or right hemispace. Coupling of the parameters of the two hands was evident such that, compared with a unimanual baseline, Initiation time of the intact right hand deteriorated while it improved for the anarchic left hand.
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Affiliation(s)
- Ada Kritikos
- School of Psychology, Victoria University of Technology, St Albans Campus, Melbourne, Victoria 8001, Australia.
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Rabbani O, Bowen LE, Watson RT, Valenstein E, Okun MS. Alien limb syndrome and moya-moya disease. Mov Disord 2004; 19:1317-20. [PMID: 15390006 DOI: 10.1002/mds.20155] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
We present the case of a 29-year-old woman with an alien limb and callosal disconnection syndrome who was diagnosed with moya-moya disease. We discuss the potential mechanisms responsible for the alien limb syndrome.
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Affiliation(s)
- Omid Rabbani
- Department of Neurology, McKnight Brain Institute, University of Florida, Gainesville, Florida 32610, USA
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Carrilho PE, Caramelli P, Cardoso F, Barbosa ER, Buchpiguel CA, Nitrini R. Involuntary hand levitation associated with parietal damage: another alien hand syndrome. ARQUIVOS DE NEURO-PSIQUIATRIA 2001; 59:521-5. [PMID: 11588628 DOI: 10.1590/s0004-282x2001000400007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The alien hand syndrome (AHS) usually consists of an autonomous motor activity perceived as an involuntary and purposeful movement, with a feeling of foreignness of the involved limb, commonly associated with a failure to recognise ownership of the limb in the absence of visual clues. It has been described in association to lesions of the frontal lobes and corpus callosum. However, parietal damage can promote an involuntary, but purposeless, hand levitation, which, sometimes, resembles AHS. In the present study, four patients (cortico-basal ganglionic degeneration - n=2; Alzheimer's disease - n=1 and parietal stroke - n=1) who developed alien hand motor behaviour and whose CT, MRI and/or SPECT have disclosed a major contralateral parietal damage or dysfunction are described. These results reinforce the idea that parietal lobe lesions may also play a role in some patients with purposeless involuntary limb levitation, which is different from the classic forms of AHS.
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Affiliation(s)
- P E Carrilho
- Department of Neurology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
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Abstract
This is a comprehensive literature review of the motor abnormalities that have come to be included under the designation of Alien Hand Phenomena (AHP). Some of the disorders are dyspractic in nature - intermanual conflict, mirror movements, interference etc., while others - groping, grasping with inability to release, utilization etc. are frontal lobe reflexes. AHP are mainly associated with two pathological processes: 1) Infarction or hemorrhage in the territory of the anterior cerebral arteries; and 2) Corticobasal degeneration. Included in the review is a description of AHP in six personal cases of corticobasal degeneration. The summary includes a short discussion of the possible anatomy of 'free will' based on AHP.
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Affiliation(s)
- C M Fisher
- Neurology Service of the Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA
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21
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Groom KN, Ng WK, Kevorkian CG, Levy JK. Ego-syntonic alien hand syndrome after right posterior cerebral artery stroke. Arch Phys Med Rehabil 1999; 80:162-5. [PMID: 10025490 DOI: 10.1016/s0003-9993(99)90114-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The alien hand syndrome classically consists of involuntary movements accompanied by a feeling of foreignness and personification of the affected limb. Autocriticism, in which patients criticize and express astonished frustration with the behavior of the autonomous limb, is a commonly noted feature. Most cases of alien hand are associated with lesions of the supplementary motor areas of the frontal lobes, the corpus callosum, or both. The authors report on a 79-year-old man who sustained a right posterior cerebral artery distribution infarction and developed alien hand syndrome in the absence of callosal involvement. Also unique is that the patient perceived the alien hand as acceptable and positive, not hostile and repugnant. This case suggests not only that the neuroanatomic regions responsible for alien hand syndrome may require re-examination, but also that its definition may need expansion.
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Affiliation(s)
- K N Groom
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA
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