Sequelae of a left-sided parietal stroke: Posterior alien hand syndrome

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.

Alien Hand Syndrome

“…In comparison, it commonly improves weeks to months following a stroke [15,30,37]. It may also be short-lived or intermittent in metabolic causes, multiple sclerosis or stroke [38,39]. While it mainly affects middle-aged to older adults, a pediatric case has been reported associated with Parry-Romberg syndrome [40].…”

“…It was proposed that in healthy persons, the hemisphere controlling the active limb (e.g., right hemisphere controlling left arm) simultaneously suppresses the contralateral (left) hemisphere through corpus callosal connections. If those connections are damaged, then the right hemisphere is unable to inhibit the left, resulting in unwanted motor activity in the right arm [39]. Posterior variant AHS was also suggested to be a variant of a neglect syndrome, where the patient ignores the contralateral limb actions only, with preserved awareness of the remainder contralateral hemibody [68].…”

“…These include medications, botulinum toxin, mirror box therapy, visuospatial coaching techniques, distracting the affected hand, and other physical and cognitive therapies [75•, 76]. Abnormal activity may be reduced by occupying the limb (e.g., holding a cane), placing it in a glove or mitt, progressive muscle relaxation, bringing it into the contralateral visual field, and giving it verbal commands [39]. Stroke-related AHS has the best prognosis, and patient-tailored rehabilitation is often successful with AHS resolving within weeks to months, up to 24 months [15,30,68].…”

When Playing Is a Problem: An Atypical Case of Alien Hand Syndrome in a Professional Pianist

“…First of all, pAHS is classically described in non-dominant limb (Scepkowski and Cronin-Golomb, 2003) and there have been very few reports of lesions in the left hemisphere causing pAHS of the dominant right upper extremity (Carrilho et al, 2001; Rohde et al, 2002; Kessler and Hathout, 2009; Kloesel et al, 2010). Leiguarda et al (1993) described a patient who developed right AHS following neurosurgical removal of a vascular malformation from the left parietal cortex and Gondim et al (2005) reported a position-dependent levitation of the dominant limb afterward left parietal cerebrovascular accident.…”

“…The “posterior form” of AHS has been related with impairment to the thalamus, the posterolateral parietal cortex and the occipital lobe (Scepkowski and Cronin-Golomb, 2003; Prakash et al, 2011). This variant usually, though not exclusively, involves the non-dominant limb (Kessler and Hathout, 2009; Kloesel et al, 2010). The alien limb movements appear non-purposeful and non-conflictual and patients could experience involuntary levitation of the arm which may be task specific (Rohde et al, 2002; Gondim et al, 2005; Prakash et al, 2011).…”