Atypical Supernumerary Phantom Limb and Phantom Limb Pain in a Patient With Spinal Cord Injury: Case Report

Abstract

Supernumerary phantom limb (SPL) resulting from spinal cord lesions are very rare, with only sporadic and brief descriptions in the literature. Furthermore, the reported cases of SPL typically occurred in neurologically incomplete spinal cord patients. Here, we report a rare case of SPL with phantom limb pain that occurred after traumatic spinal cord injury in a neurologically complete patient. After a traffic accident, a 43-year-old man suffered a complete spinal cord injury with a C6 neurologic level of injury. SPL and associated phantom limb pain occurred 6 days after trauma onset. The patient felt the presence of an additional pair of legs that originated at the hip joints and extended medially, at equal lengths to the paralyzed legs. The intensity of SPL and associated phantom limb pain subsequently decreased after visual-tactile stimulation treatment, in which the patient visually identified the paralyzed limbs and then gently tapped them with a wooden stick. This improvement continued over the 2 months of inpatient treatment at our hospital and the presence of the SPLs was reduced to 20% of the real paralyzed legs. This is the first comprehensive report on SPLs of the lower extremities after neurologically complete spinal cord injury.

Effects of combined rTMS and visual feedback on the rehabilitation of supernumerary phantom limbs in a patient with spinal cord injury: A case report

“…Phantom limb mainly occurs after amputation and can make patients almost forget that their limbs have been removed, and they can even feel the movement or pain of amputated limbs[9]. Phantom limb has also been reported in SCI patients and has been defined as SPL[3]. In addition to their actual limbs, these patients complain of having extra limbs.…”

“…Research has demonstrated that virtual feedback has therapeutic effects on the PL following amputation and neurological injury[3,8,12]. Thus, we prescribed for our patient with virtual feedback.…”

“…The first theory is that the primary somatosensory cortex is reorganized and that the regular cerebral schema that was gained by the interaction between sensory feedback from the periphery and image formulation originating from the brain, subsequently deteriorated[15]. Secondly, central command is moved and is mismatched with sensory feedback from the periphery, which is caused by impairment of sensory roots resulting from SCI and dysfunction that failed to integrate motor information to generate normal physical experience[3]. Thirdly, cortical or subcortical brain reorganization occurs, which includes a change in brain excitability[16,17].…”

“…SPL is rare in SCI, and all reported cases have occurred following cervical cord injury[1,3,7,8]. The underlying mechanisms of SPL after SCI are unknown, and effective therapeutic methods remain to be developed.…”

Supernumerary phantom limb in a patient with basal ganglia hemorrhage - a case report and review of the literature

“…MCA territory CI Arm (1) 6 months +/− Halligan PW [ 34 ] M/65 Rt. BG ICH Arm (1) 3 days −/− Spinal or infraspinal lesion Melinyshyn AN [ 5 ] F/31 PN AIDP Arm (2) Leg (2) 54 days a / a F/57 PN AIDP Arm (2) Leg (2) 72 days +/+ F/68 PN AIDP Arm (2) Leg (2) 46 days +/+ Belgrade M [ 7 ] M/58 PN NS Toe (1) a +/+ Katayama O [ 35 ] M/22 SC (C2) TM Arm (2) 2 years −/+ Choi JY [ 36 ] M/43 SC (C6) TM Leg (2) 6 days −/+ Curt A [ 23 ] M/71 SC (C3) TM Arm (2) 7 days +/+ Sakagami Y [ 6 ] F/31 SC (C4) SjS Arm (1) a −/+ a It was not described in the literature b The number of SPL fluctuated …”