J Clin Neurol.  2009 Mar;5(1):46-48.

Right Sensory Alien Hand Phenomenon from a Left Pontine Hemorrhage

• Rafiei N
• Chang GY

Abstract

BACKGROUND: Acute onset of a sensory alien hand phenomenon has been observed only from a supratentorial lesion involving the non-dominant hand, mostly from a right posterior cerebral artery infarction. A single acute vascular lesion resulting in a dominant hand sensory alien hand syndrome has not been previously documented.
CASE REPORT
A 78-year old right-handed woman exhibited right sensory alien hand phenomenon from a left pontine hemorrhage. Disturbance of proprioceptive input and visuospatial perception are likely to play a role in manifesting the sign.
CONCLUSIONS
Dominant-hand sensory alien hand phenomenon may occur in an acute setting from a left pontine hemorrhage.

Keyword

sensory alien hand; dominant limb; pontine hemorrhage

MeSH Terms

Alien Hand Syndrome
Emigrants and Immigrants
Female
Hand
Hemorrhage
Humans
Infarction, Posterior Cerebral Artery

Figure

• 

  Fig. 1 A: Non-enhanced CT at the level of mid-upper pons demonstrating foci of hemorrhage adjacent to the floor of the 4th ventricle. Less dense hemorrhage extends to the left pontine tegmentum. B: Somatosensory evoked potentials (SSEP) from median nerve stimulation demonstrating absence of cortical response from the right hand.

Reference

1. Scepkowski LA, Cronin-Golomb A. The alien hand: cases, categorizations, and anatomical correlates. Behav Cogn Neurosci Rev. 2003. 2:261–277.

2. 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. 87:728–732.

3. Evyapan D, Kumral E. Pontine anosognosia for hemiplegia. Neurology. 1999. 53:647–649.

4. Tanaka H, Arai M, Kadowaki T, Takekawa H, Kokubun N, Hirata K. Phantom arm and leg after pontine hemorrhage. Neurology. 2008. 70:82–83.

5. Pizoli CE, Jinnah HA, Billingsley ML, Hess EJ. Abnormal cerebellar signaling induces dystonia in mice. J Neurosci. 2002. 22:7825–7833.

6. LeDoux MS, Brady KA. Secondary cervical dystonia associated with structural lesions of the central nervous system. Mov Disord. 2003. 18:60–69.

7. Mariën P, Verhoeven J, Brouns R, De Witte L, Dobbeleir A, De Deyn PP. Apraxic agraphia following a right cerebellar hemorrhage. Neurology. 2007. 69:926–929.