Ann Rehabil Med.  2012 Aug;36(4):556-560. 10.5535/arm.2012.36.4.556.

Alien Hand Syndrome in Stroke: Case Report & Neurophysiologic Study

• Park YW
• Kim CH
• Kim MO
• Jeong HJ
• Jung HY

• KMID: 2266728
• DOI: http://doi.org/10.5535/arm.2012.36.4.556

Abstract

Alien Hand Syndrome is defined as unwilled, uncontrollable, but seemingly purposeful movements of an upper limb. Two major criteria for the diagnosis are complaint of a foreign limb and complex, autonomous, involuntary motor activity that is not part of an identifiable movement disorder. After a cerebrovascular accident in the corpus callosum, the parietal, or frontal regions, various abnormal involuntary motor behaviors may follow. Although different subtypes of Alien Hand Syndrome have been distinguished, this classification clearly does not cover the wide clinical variety of abnormal motor behaviors of the upper extremity. And there are few known studies about the neurophysiology of this syndrome using transcranial magnetic stimulation (TMS). We recently experienced 2 rare cases of Alien Hand Syndrome which occurred after anterior cerebral artery (ACA) infarction. A 72 year-old male with right hemiplegia following a left ACA infarct had difficulty with voluntarily releasing an object from his grasp. A 47 year-old female with left hemiplegia following a right ACA infarct had a problem termed 'intermanual conflict' in which the two hands appear to be directed at opposing purposes. Both of them had neurophysiologic studies done, and showed reduced amplitude by single pulse MEP and a lack of intracortical inhibition (ICI) by paired pulse TMS. No abnormalities were found in SSEP.

Keyword

Alien hand syndrome; Anterior cerebral artery infarction; Neurophysiologic studies

MeSH Terms

Alien Hand Syndrome
Anterior Cerebral Artery
Corpus Callosum
Emigrants and Immigrants
Extremities
Female
Hand
Hand Strength
Hemiplegia
Humans
Infarction
Infarction, Anterior Cerebral Artery
Male
Motor Activity
Movement Disorders
Neurophysiology
Stroke
Transcranial Magnetic Stimulation
Upper Extremity

Figure

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  Fig. 1 Axial magnetic resonance image showing a high signal and indicating an acute infarction in the left frontal periventricular white matter on a diffusion weighted image (Case 1).

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  Fig. 2 Axial magnetic resonance image showing a high signal and indicating an acute infarction in the right frontal lobe and corpus callosum on a diffusion weighted image (Case 2).

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