Alien hand syndrome: An atypical presentation of acute left parietal stroke in a community emergency department.

A case of Alien hand syndrome as a presentation of an acute left parietal stroke to improve emergency providers recognition of the condition as a manifestation of acute stroke. We report a case of an 81-year-old female who presented with a complaint of inability to control her right arm accompanied with a subjective sense of right upper extremity numbness and weakness. It was later identified that the patient had an acute left parietal stroke and was describing alien hand syndrome, described as involuntary movements of the right hand and upper extremity. This presentation of stroke is important for emergency providers to recognize as it is uncommon, greater awareness by emergency providers may improve stroke outcomes by early detection and activation of routine acute stroke interventions. SUMMARY: In this case report a patient presented with alien hand syndrome, with inability to control her right hand along with a subjective complaint of numbness and reduction in strength in the right upper extremity, found to be due to an acute left parietal stroke that was confirmed by MRI imaging.

Alien hand syndrome in ruptured aneurysms: case report and review of the literature.

Alien hand syndrome is a rare condition associated with lesions of the corpus callosum and of the supplementary motor area, which can be caused by ruptured cerebral aneurysms. We present a novel case of a patient with a subarachnoid haemorrhage from an aneurysm of the anterior communicating artery who developed alien hand syndrome and intermanual conflict. In addition, we performed a systematic literature search and evaluated data on clinical presentation, treatment and radiological findings from relevant papers. To date, 17 cases of alien hand syndrome in aneurysmatic subarachnoid haemorrhage have been reported. Aneurysms of the anterior communicating artery were the most common origin of subarachnoid haemorrhage (10/17), followed by pericallosal artery aneurysms (7/10). The prognosis appears to be favourable; however, damage to the supplementary motor area during treatment should be avoided to keep symptoms minimal.

Alien hand syndrome and migraine with aura: A case report.

BACKGROUND: Alien Hand Syndrome (AHS) is an uncontrollable, involuntary, but in appearance, purposeful motor control disorder of the upper extremity. CASE REPORT: A 42-year-old male patient was admitted to our clinic complaining of involuntary motor activity in his right hand. He had a previous history of migraine with visual aura. The uncontrollable motor control disorder was compatible with Alien Hand Syndrome, which was appearing immediately after the visual aura and before the beginning of headache. CONCLUSION: Alien Hand Syndrome is usually observed with anterior cerebral artery infarction, midline tumors, trauma and several neurodegenerative diseases, but is rarely seen in paroxysmal conditions such as migraine with aura.

Alien hand syndrome: Pathophysiology, semiology and differential diagnosis with psychiatric disorders (Review).

Alien hand syndrome (AHS) is an uncommon neurological condition characterized by involuntary, yet seemingly purposeful, movements of a limb, typically an upper extremity, with variable awareness and control by the affected individual. It is associated with a range of peculiar sensations, such as the feeling of limb estrangement, alien control and involuntary mirroring or restraining of movements. AHS indicates a profound disruption in volitional motor control and personal agency. The aetiology of AHS is the dysfunction of critical brain regions secondary to diverse neurological insults, such as tumours, vascular disorders, infarction or neurodegenerative diseases. It is clinically categorized into the parietal and callosal types, depending on the affected region, with manifestations often linked to the specific brain region affected. The callosal type is particularly challenging to diagnose due to its rarity and potential for nonspecific or concealed symptoms amid concurrent brain injuries. Distinguishing AHS from psychiatric disorders is crucial for accurate diagnosis and improved patient outcomes. Further research is imperative for a deeper understanding of the pathophysiology of AHS and the development of effective treatments. AHS predominantly affects adults and is frequently associated with multiple comorbidities. The syndrome is also exemplified by three distinct motor behaviours: Involuntary grasping, inter-manual conflict and limb levitation accompanied by the sensation of an alien limb or the perception of external control over one's movements. It has a generally good prognosis with partial or total recovery following appropriate rehabilitation techniques, including pharmacological and psychological measures.

Alien Hand Syndrome Unveiled in a Patient With Right Middle Cerebral Artery Stroke.

Alien hand syndrome (AHS) is a rare but significant disorder, characterized by involuntary and often complex movements of one's hand. These movements seem to occur independently and unconsciously, separate from a person's intended actions.  We report a case of a 70-year-old male who presented to the emergency department with left sided hemiplegia following a stroke in the right middle cerebral artery (MCA) that affected the right temporal, parietal and internal capsule region. Upon additional inquiry, the patient reported experiencing involuntary, abrupt movements in his left upper and lower limbs particularly while attempting voluntary movements. As per the patient, these symptoms occurred prior to the onset of limb weakness. The diagnosis of AHS was made after excluding other differentials based on the clinical, metabolic and radiological picture.  Our patient exhibited unique symptoms and had a different presentation from that mentioned in the literature, as the onset of symptoms preceded the development of limb weakness typically associated with stroke. Involvement of the upper and lower limb and onset of symptoms prior to limb weakness make this case exceptionally rare. Moreover, acknowledging alien hand/limb syndrome as a distinct condition, separate from the broad category of post-stroke movement disorder, carries significant implications for both the management and prognosis of affected individuals.

Alien hand syndrome, a rare presentation of corpus callosum and cingulate infarction.

Alien hand syndrome (AHS) is a rare apraxia syndrome, characterized by involuntary and uncontrollable movements of one upper limb, often accompanied by intermanual conflict. Damage to the corpus callosum, acute infarction and neurodegenerative disease may result in AHS. Based on the presentation and impairment region, AHS has three variants: frontal, callosal and posterior. Each type may have a different clinical presentation. A total of 157 patients admitted to hospital with corpus callosum infarction between 2012 and 2022 were included for this study, of whom a number of 5 presented with AHS. 4 of them had significant symptoms of intermanual conflict and 1 had strong grip symptoms in the affected upper limb. Moreover, new infarcts involving the corpus callosum and cingulate gyrus were found on MRI in all five patients. We simultaneously performed a retrospective study on all reported AHS cases caused by infarction of the corpus callosum. Case reports and literature reviews were conducted in order to provide clinicians with a better understanding of AHS, its etiology, clinical presentation, diagnosis, and treatment.

Case report: Self-restraint in a patient with alien hand syndrome following cerebral infarction involving the anterior cerebral artery territory.

Frontal alien hand syndrome (AHS) presents as impulsive grasping and groping and compulsive manipulation of environmental objects that can affect the dominant or nondominant hand. A few reports have shown improvements in neuropsychological scores over time when self-restraint of the right hand AHS was enforced. A 72-year-old woman presented with right-handed involuntary instinctive grasping reactions and compulsive manipulation of tools after an infarction of the frontal lobe and corpus callosum (CC). She was diagnosed with cerebral infarction involving the anterior cerebral artery territory and a frontal variant of AHS. At AHS onset, the patient was unaware that her right hand was moving against her will; she was only aware that her right hand was moving when the therapist pointed it out to her. Later, she began to recognize that her right hand was involuntarily moving, and she could restrain the movement of her right hand with her left hand. Approximately 5 months following AHS onset, the patient could voluntarily restrain her AHS symptoms by telling her right hand not to move against her will in her head. Most neuropsychological scores improved by 5 months following AHS onset. However, the patient showed disruptions in the genu and midbody of the left cingulate cortex, as shown via diffusion tensor imaging (DTI), and the sensation of the "right hand moving by itself" remained even 5 months after AHS onset. Although damage to the CC fibers was evident on DTI at 5 months following onset, the patient exhibited no sensory deficits and demonstrated good hand ownership as well as early improvement in attention and cognitive dysfunction. Therefore, the patient recognized her AHS symptoms, which included her hand moving against her will, and was able to consciously restrain her hand movement.

Case Report: Callosal disconnection syndrome manifesting as mixed frontal-callosal-posterior alien hand syndrome following extensive corpus callosum infarct.

Alien hand syndrome (AHS) is a rare neurological phenomenon first described by Van Vleuten over a century ago. The most widely recognized variants in literature are frontal, callosal, and posterior AHS. AHS due to the corpus callosum lesion can occur alone or as part of callosal disconnection syndrome (CDS). This report presents a unique CDS case manifesting clinical features from all three AHS variants, resulting from an extensive corpus callosum infarct. Our patient exhibited various clinical features from the three AHS variants, which include grasping, groping, and difficulty releasing objects from the hand (anterior); intermanual conflict (callosal); arm levitation, mild hemiparesis, and hemisensory loss (posterior). Additionally, the extensive disruption of the corpus callosal fibers produced neurological manifestations of CDS, such as cognitive impairment, ideomotor and constructional apraxia, behavioral disorder, and transcortical motor aphasia. We employed a range of rehabilitation interventions, such as mirror box therapy, limb restraint strategy, verbal cue training, cognitive behavioral therapy, bimanual hand training, speech and language therapy, and pharmacological treatment with clonazepam. The patient showed almost complete resolution of CDS and AHS features by nine months post-stroke Our case report highlights distinctive clinical variations of AHS and the challenging correlation between clinical manifestations and neuroanatomical substrates. Future studies are necessary to explore the intricate neural connections and the precise function of the corpus callosum. This can be achieved by combining comprehensive neuropsychological testing with diffusion tensor tractography studies. It is also essential to develop a validated tool to standardize AHS assessment. Finally, the scarcity of evidence in rehabilitation interventions necessitates further studies to address the wide knowledge gap in AHS and CDS management.

An Investigation on the Preconditions and Diagnosis Methods for Alien Hand Syndrome.

Although it is not a very common condition, people who have suffered from neuro-damage or neuro-diseases are at risk for developing a condition known as Alien hand syndrome (AHS). Individuals who have this condition are unable to control the movement of their hands for certain brief intervals of time. In order to improve upon the treatment of individuals with AHS, it is important that signs and symptoms of the disease are identified as soon as possible. The purpose of this investigation is to catalog the data regarding the pre-existing conditions and the method of diagnosis for AHS. Within the review, it was revealed that stroke was the most common pre-existing condition for the disease. Therefore, physicians who have stroke patients within their care should carefully monitor their condition in case they do develop AHS. Additionally, it was found that using an MRI machine was the most common method of diagnosing a patient with AHS. This was most likely because MRI scans provide the most information about a patient's brain functionality which can be used to deduce if an individual has AHS.

[Frontotemporal dementia with cortico-basal syndrome]. / Lobno-visochnaya dementsiya s kortikobazal'nym sindromom.

FTD is a group of neurodegenerative diseases with progressive deterioration of behavioral and speech disorders, morphologically associated with pathology of the frontal or temporal lobes. International clinical trials have made it possible to define modern diagnostic criteria for various subtypes of clinically «possible/probable¼ FTD. Our article is devoted to one of the rare subtypes of frontotemporal dementia (FTD), corticobasal syndrome (CBD), in which we presented a review of current data with a demonstration of clinical observation. A clinical case of a patient with a patient with speech disorders and memory impairment is presented. A 60-year-old man at the time of the outpatient visit had been complaining of speech impairment for two years, a slight decrease in memory for current events. Neurological and neuropsychological studies revealed two leading clinical syndromes in the patient: «frontal¼ syndrome with impaired higher cortical functions in the form of efferent motor aphasia, impaired writing and reading with visual-spatial agnosia and dysgraphia, «frontal¼ signs (positive «palm-mouth «and¼ grasping «reflexes); «Corticobasal syndrome¼ with pronounced dynamic, optic-kinesthetic dyspraxia, dermolexia, apraxia of closing the eyes, «alien¼ hand syndrome with symptoms of levitation and intermanual conflict. MRI diagnostics revealed changes characteristic of neurodegeneration of the frontotemporal type (atrophy of the frontal and temporal lobes prevails). Taking into account complaints, anamnesis of the disease, identified clinical syndromes and structural changes according to MRI data, the patient was diagnosed with a clinically «probable¼ FTD. Determination and accurate diagnosis of FTD subtypes will help the neurologist in managing these patients with the appointment of the correct pharmacologic treatment. In FTD, in contrast to AD patients, the administration of cholinesterase inhibitors does not lead to a positive therapeutic effect a positive therapeutic effect and, therefore, is not advisable. The standards of patient therapy should include recommendations for antipsychotic therapy, the use of antidepressants (SSRIs) and anxiolytics with nootropic effects for the correction of affective and behavioral disorders.

Unilateral neglect or alien hand syndrome? A diagnostic challenge.

Alien hand syndrome (AHS) is a rare post-stroke complication. Although the occurrence of AHS after stroke is rare, it can have a disabling impact on the lifestyle and career of the patients post stroke. It is difficult to distinguish AHS from the non-dominant hemispheric infarction with symptoms of hemianopia and left hemineglect, as patients with AHS can also have neglect as well as behaviour symptoms if the frontal lobe is involved. We report the case of a 62-year-old gentleman who was admitted to the rehabilitation ward and was treated for neglect and apraxia following right middle cerebral artery stroke. After further re-evaluation, the patient was diagnosed with AHS. Functionally, he improved and the symptoms disappeared four months after the stroke. In this case report, we highlight the features of AHS and provide a unique management approach.

Rehabilitation of a Patient with Alien Hand Syndrome: a Case Report of a 61-Year Old Man.

OBJECTIVE: Alien hand syndrome is a rare neurological disorder in which the patient makes seemingly purposeful movements of one hand, which are dissociated from any conscious intent. These abnormal movements are very annoying, and can be disabling, for the patient. There is no established effective treatment for alien hand syndrome. METHODS: Report of a case of a 61-year old man with frontal variant of alien hand syndrome following ischaemic stroke. RESULTS: During therapy, the patient unwittingly grabbed objects with his right hand and could not voluntarily release his grip. Multidisciplinary rehabilitation was started, with learning of compensation strategies and a focus on bimanual tasks. Follow-up after 5 months showed a major improvement in the Functional Index Measure (FIM) score, an improvement from 36 to 79 on 126 scored items. CONCLUSION: It is important to recognize this rare syndrome because of its disabling character. Evidence about the best treatment for alien hand syndrome is scarce. There is an important role for specific exercises and patient education. During rehabilitation of the patient, most improvement occurred with bimanual tasks and different colours (black, white and other bright colours) to navigate the subject's attention more to one side. Another exercise strategy was letting the alien hand catch a cube, after which the patient was able to perform more exercises with the other hand during one - handed training. In the current case, the alien hand syndrome resolved following specific and multidisciplinary rehabilitation.

Case Report: Good Prognosis of Mixed Alien Hand Syndrome by Verbal-Cue Rehabilitation Exercise.

Mixed alien hand syndrome is a rare disease reported in the literature. The mixed callosal-frontal variant of alien hand syndrome is associated with uncoordinated hand movements, and patients may present with an involuntary grasp reflex and intermanual conflict. There are few videos in the existing literature on the comparison of patients' condition before and after recovery of the symptoms of mixed alien hand syndrome. We presented the prognosis of mixed alien hand syndrome in the form of a video. In addition, we have included some videos on the comparison of the condition of patients before and after recovery of the symptoms of mixed alien hand syndrome. A 57-year-old woman presented with left-handed intermanual conflict and right-handed involuntary grasp reflex due to infarction of the frontal lobe and corpus callosum. She was diagnosed with a mixed callosal-frontal variant of alien hand syndrome. Her left hand counteracted the purposeful movements of the right hand. However, the intermanual conflict disappeared after 3 months of therapy, including drug treatment and verbal-cue rehabilitation, and she regained normal coordination of her hand movements. Her prognosis was good despite the large corpus callosum lesions. The uncoordinated hand movements of the patient affected her daily life and caused psychological problems. Initiating rehabilitation early was important and necessary for her to regain coordination. It is possible that the verbal-cue training method played an important role in the recovery of the patient. Therefore, this method of rehabilitation deserves consideration and can be adopted in larger cohort studies as we presented only a single case. The possible mechanisms behind the verbal-cue exercise require further studies, and this patient had a good prognosis despite severe corpus callosum injury, which may merit further investigation.

Alien hand syndrome - a rare presentation of stroke.

Alien Hand Syndrome (AHS) is characterized by intermittent and involuntary movements of a single limb that is not associated with motor dysfunction. AHS may be the initial presentation of serious underlying pathology, such as stroke localized to the non-dominant parietal lobe, corpus callosum damage, or neurodegenerative disease. AHS occurs at a low prevalence in the general population yet represents significant underlying disease burden, necessitating early identification. In this case report, we present an 88-year-old right-handed male with involuntary movement of his left forearm and hand three hours prior to presentation. His symptom corresponded to findings on MRI of the brain, which showed acute infarcts of the right temporal lobe, right parietal cortex, and right parietal subcortex. Infarction of the right parietal cortex accounted for his AHS. The multifocal nature of the infarcts elevated the index of suspicion for an embolic source.

A case of transient alien hand syndrome from a very small ischemic stroke.

Posterior alien hand syndrome caused by small infarcts seems to be characterized by acute development and transient, yet profound, isolated motor dysfunction with a favorable prognosis unlike other cases due to larger MCA infarcts.

Posterior Alien Hand Syndrome from Acute Ischemic Left Parietal Lobe Infarction.

Alien hand syndrome (AHS) is defined as an involuntary goal-directed movement of the hand as if acting on its own will, or as being under the control of someone else. Moreover, the affected hand typically does not show any signs of weakness or convulsive movement. The cause of AHS is associated with an insult to the brain from various conditions such as stroke, trauma, tumor, aneurysm, neurosurgical intervention, infection, and degenerative brain diseases. We hereby illustrate a case of a patient with chronic atrial dysrhythmia whose oral anticoagulation therapy was placed on hold by his gastroenterologist for a scheduled colonoscopy. The patient presented to the hospital with symptoms of right-hand paresthesia with uncontrolled movement. These symptoms were seen along ST-segment elevation in the inferior leads on a 12 lead electrocardiogram. The case report acknowledges an unusual presentation of acute ischemic stroke, which may be frightening and bewildering to patients, their families, and any healthcare providers, including neurologists, who may have encountered it for the first time. Also, our patient had posterior AHS, likely from infarction involving the left inferior parietal lobe, which is reported to have a low prevalence.

The Senses of Agency and Ownership: A Review.

Usually, we do not question that we possess a body and act upon the world. This pre-reflective awareness of being a bodily and agentive self can, however, be disrupted by different clinical conditions. Whereas sense of ownership (SoO) describes the feeling of mineness toward one's own body parts, feelings or thoughts, sense of agency (SoA) refers to the experience of initiating and controlling an action. Although SoA and SoO naturally coincide, both experiences can also be made in isolation. By using many different experimental paradigms, both experiences have been extensively studied over the last years. This review introduces both concepts, with a special focus also onto their interplay. First, current experimental paradigms, results and neurocognitive theories about both concepts will be presented and then their clinical and therapeutic relevance is discussed.

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

Alien hand syndrome (AHS) is a neurological illness characterized by limb movements which are carried out without being aware of it. Many patients describe these movements as aggressive and some perceive a strong feeling of estrangement and go so far as to deny ownership. The sense of body ownership is the perception that parts of one's body pertain to oneself, despite it is moving or not and if movement is intentional or unintentional. These anomalous self-experiences may arise in patients with focal brain lesions and provide unique opportunities to disclose the neural components underlying self-body perception. The feeling of foreignness described in AHS is often observed in post-central cortical lesions in the non-dominant hemisphere and is typical of the "posterior alien hand variant". We used Diffusion-Tensor magnetic resonance imaging (DT-MRI) in an unusual case of posterior AHS of the dominant hand in a professional pianist with corticobasal syndrome (CBS). The patient showed uncontrolled levitation with the right arm while playing the piano and perceived as if her hand had a "mind of its own" which prevented her from playing. MRI-scans show asymmetric brain atrophy, mainly involving left post-central regions and SPECT-Tc99m-ECD patterns of hypometabolism over the left parietal-occipital cortices. DT-MRI revealed extensive damage which comprised left fronto-temporal cortex and extends into the ipsilateral parietal cortex causing a disruption of corpus callosum (CC) projections from the rostrum to the splenium. Our case illustrates that posterior AHS may occur in the dominant hemisphere due to widespread damage, which exceed parietal cortex. The parietal lobe has been recognized as a multimodal association region that gets input from several networks and organizes motor output. We suggest that the disturbance to this pathway could result in disruption of motor output and associate an abnormal motor control and anomalous self-body perception.

Alien hand syndrome following corpus callosum infarction: A case report and review of the literature.

Alien hand syndrome (AHS) is characterized by involuntary and autonomous activity of the affected limbs, and consists of the frontal, callosal and posterior AHS variants. The callosal subtype, resulting from damage to the corpus callosum, frequently features intermanual conflict. However, infarction of the corpus callosum is rare due to abundant blood supply. The present study reported a case of AHS (callosal subtype, in the right hand) caused by callosal infarction. Infarction of the left corpus callosum was confirmed with magnetic resonance imaging. In addition, magnetic resonance angiography and digital subtraction angiography examinations revealed multiple lesions in the feeding arteries. Subsequent to antiplatelet therapy for 2 weeks following admission, the patient gradually recovered. Furthermore, the current study reviewed 31 previously reported cases of AHS following callosal infarction in the literature.

Paroxysmal posterior variant alien hand syndrome associated with parietal lobe infarction: case presentation.

Alien hand syndrome (AHS) is an involuntary and rare neurological disorder emerges at upper extremity. AHS is a disconnection syndrome with the symptoms of losing sense of agency and sense of ownership, and presence of involuntary autonomic motor activity. There are frontal, callosal and posterior types of AHS and each of them occurs depend on the lesions of different of the brain. Posterior variant is a rarely encountered AHS type compared to others. AHS, generally regarded as persistent, but rarely maybe observed as paroxysmal. In this article, we present 71 year old patient with right posterior parietal lobe infarction and developed posterior variant AHS on left arm 1 month after discharge from the hospital. To discriminate AHS from conditions such as extrapyramidal movement disorders and epileptic seizures that take part in differential diagnosis should be kept in mind by the clinicians. Wrong and unnecessary treatments could be prevented in this way.