Neurology
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Figures Only
Right arrow Full Text (PDF)
Right arrow Videos
Right arrow Italian Translation
Right arrow Correspondence:
Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Correspondence are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Espinosa, P. S.
Right arrow Articles by Berger, J. R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Espinosa, P. S.
Right arrow Articles by Berger, J. R.
Related Collections
Right arrow MRI
Right arrow All Neuropsychology/Behavior
Right arrow Neglect
NEUROLOGY 2006;67:E21
© 2006 American Academy of Neurology
Resident and Fellow Page

Alien hand syndrome

Patricio S. Espinosa, MD, MPH, Charles D. Smith, MD and Joseph R. Berger, MD

Address correspondence and reprint requests to Dr. Patricio S. Espinosa, Department of Neurology, Kentucky Clinic (Room L-445), Lexington, Kentucky 40536-0284; e-mail:psespi2{at}email.uky.edu

A 47-year-old right-handed man presented with sudden onset of left-sided weakness and incoordination of his left hand. The patient stated that he was not able to operate his left hand appropriately (video E-1). On examination, he had mild weakness in his left arm and leg. When asked to perform tasks with his right hand, his left hand would imitate the other (video E-2). An MRI showed acute ischemic strokes of the right parietal area and anterior corpus callosum (figure).


Figure 157
View larger version (68K):
[in this window]
[in a new window]

  		Figure. MRI of the brain DWI and FLAIR showing the acute stroke in the right parietal lobe and anterior corpus callosum (see file 1).

 

Alien hand syndrome (AHS) or alien limb sign includes failure to recognize ownership of one's limb when visual cues are removed, a feeling that one body part is foreign, personification of the affected body part, or autonomous activity which is perceived as outside voluntary control.1 Although the hand is most frequently affected, any limb or combination of limbs may fulfill the alien limb criteria.1

Two types of AHS have been described. Frontal AHS occurs in the dominant hand and is associated with reflexive grasping, groping, and compulsive manipulation of tools. It is a result of damage to the supplementary motor area, anterior cingulate gyrus, and medial prefrontal cortex of the dominant hemisphere and anterior corpus callosum. Callosal AHS is characterized by intermanual conflict and requires only an anterior callosal lesion. Callosal AHS is best explained by hemispheric disconnection manifested during behaviors requiring dominant hemisphere control.2

We hypothesize that the alien limb symptoms that our patient demonstrated were secondary to the lesion in the anterior corpus callosum; however, some of his behavioral manifestations may have been exacerbated by the concurrent right parietal stroke. The latter may be associated with hemispa-tial neglect, typically characterized by directional hypokinesia for actions into and toward contralesional hemispace or failure to respond to stimuli on the left side.3 Anosognosia, or unawareness of the neurologic deficit, is frequent after right parietal lesions, and may compound the disability deriving from the neglect itself,3,4 although no characteristic features of neglect were observed in our patient.

Footnotes

Disclosure: The authors report no conflicts of interest.

References

  1. Doody RS, Jankovic J. The alien hand and related signs. J Neurol Neurosurg Psychiatry 1992;55:806–810.[Abstract/Free Full Text]
  2. Feinberg TE, Schindler RJ, Flanagan NG, Haber LD. Two alien hand syndromes. Neurology 1992;42:19–24.[Abstract/Free Full Text]
  3. Buxbaum LJ, Ferraro MK, Veramonti T, et al. Hemispatial neglect: subtypes, neuroanatomy, and disability. Neurology 2004;62:749–756.[Abstract/Free Full Text]
  4. Levine DN, Calvanio R, Rinn WE. The pathogenesis of anosognosia for hemiplegia. Neurology 1991;41:1770–1781.[Abstract/Free Full Text]




This Article
Right arrow Figures Only
Right arrow Full Text (PDF)
Right arrow Videos
Right arrow Italian Translation
Right arrow Correspondence:
Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Correspondence are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Espinosa, P. S.
Right arrow Articles by Berger, J. R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Espinosa, P. S.
Right arrow Articles by Berger, J. R.
Related Collections
Right arrow MRI
Right arrow All Neuropsychology/Behavior
Right arrow Neglect

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS