Transient alien hand syndrome, in a chronic depressive patient with recent Anterior Corpus Callosum Infarct.
Abstract
Abstract Introduction The term alien hand refers to a variety of clinical conditions characterized by the uncontrolled behavior or the feeling of strangeness of one extremity, most commonly the left hand. A common classification distinguishes it as the anterior motor form(1) and posterior sensory form. Symptoms following callosal lesions may or may not be accompanied by hemispheric damage, especially in the frontal medial region however Della Sala et al(15) Goldberg et al(14) have argued that, frontal lesion alone is sufficient to explain alien hand syndrome and callosal lesion need not be present.Case Report 59 year old female, a known case of depression with CVA, Hypertension and Diabetes mellitus presented with irrelevant talk, altered behavior, inability to recognize familiar faces objects and decreased self care. Examination revealed stable vitals, positive neurological findings were 7th nerve UMN palsy on left side with left sided hemiparesis, ill sustained attention, slurred speech, decline in constructional ability. Lobar function tests revealed dyscalculia, right- left disorientation, hemi neglect, finger agnosia, left limb apraxia and difficulty in bimanual coordination. Clinical diagnosis was CVA-multi infarct predominantly involving fronto parietal with left hemiparesis. Neuroimaging showed anterior corpus callosum infarct with gliosis in right parietal region confirmed the clinical features and Transient Alien hand syndrome. Neurologist concurred with same findings and patient showed improvement within few weeks of initiating treatment. Discussion and Conclusion In this patient the presence of limb apraxia and difficulty in bimanual coordinaton pointed towards the need for detailed work up and MRI revealed anterior corpus callosum infarct. Alien hand syndrome may be presenting with wide spectrum of motor and sensory deficits which may be caused by parietal, frontal or callosal lesions. This patient is a case of Transient Alien hand syndrome, probably due to motor involvement as a result of anterior corpus callosum infarct. Further research may be needed to conclude these findings
Full Text:
PDFReferences
F. Aboitiz • X. Carrasco • C. Schröter • D. Zaidel • E. Zaidel • M. Lavados The alien hand syndrome: classification of forms reported
anddiscussion of a new condition Neurol Sci (2003) 24:252–257
DOI 10.1007/s10072-003-0149-4
The alien hand and related signs
Rachelle Smith Doody, Joseph Jankovic. journalof Neurology, Neurosurgery, and Psychiatry 1992;55:806-810
Callosal disconnection syndrome and knowledge of the body: a case of left hand isolation from the body schema with names Toyoko Nagumo, Atsushi Yamadori journalof Neurology, Neurosurgery, and Psychiatry 1995;59:548-551
Conflict of intentions due to callosal disconnection T Nishikawa, J Okuda, I Mizuta, K Ohno, J Jamshidi, H Tokunaga, Y Ikejiri, Y Nakagawa, T Yoshimine, H Tanabe,M Takeda Neurol Neurosurg Psychiatry 2001;71:462–471
Clinical and topographical range of callosal infarction: a clinical and radiological Correlation study Maurice Giroud, Raymond Dumas, journalofNeurology, Neurosurgery, and Psychiatry 1995;59:238-242
Corpus Callosum Infarcts with Atypical Clinical and Radiologic Presentations David L. Kasow, Sylvie Destian, Carl Braun, John C. Quintas, Nolan J. Kagetsu, and Carl E. Johnson AJNR Am J Neuroradiol 21:1876–1880, November/December 2000.
Akelaitis AJ, Risteen W, Herren R, Van Wagenen W (1942) Studies of the corpus callosum. III. A contribution to the study of dyspraxia and apraxia following partial and complete section of the corpus callosum. Arch Neurol Pyschiatry 47:971–1008
Akelaitis AJ (1945) Studies of the corpus callosum. IV. Diagonistic dyspraxia in epileptics following partial and complete section of the corpus callosum. Am J Psychiatry 101:594–599
TanakaY, Iwasa H, Yoshida M (1990) Diagonistic dyspraxia: case report and movement-related potentials. Neurology 40:657–661
Tanaka Y, Yoshida A, Kawahata N, Hashimoto R, Obayashi T (1996) Diagonistic dyspraxia. Clinical characteristics, responsible
lesion and possible underlying mechanism. Brain 119:859–873
(4):257-66.
Chan JL, Liu AB (1999) Anatomical correlates of alien hand syndrome. Neuropsychiatry Neuropsychol Behav Neurol 12:149–155
Feinberg TE, Schindler RJ, Flanagan NG, Haber LD (1992) Two alien hand syndromes. Neurology 42:19–24
Parkin AJ, Barry C (1991) Alien hand sign and other cognitive deficits following ruptured aneurysm of the anterior communicating artery. Behav Neurol 4:167–179
Goldberg G, Mayer N, Toglia J (1981) Medial frontal cortex infarction and the alien hand sign. Arch Neurol 38:683–686
Della Sala S, Marchetti C, Spinnler H (1991) Right-sided
anarchic (alien) hand: a longitudinal study. Neuropsychologia 29:1112–1117
Ay H, Buonanno FS, Price BH, Le DA, Koroshetz WJ (1998) Sensory alien hand syndrome: case report and review of the literature. J Neurol Neurosurg Psychiatry 65:366–369
Persaud RS (1999) Sensory alien hand syndrome. J Neurol Neurosurg Psychiatry 67:130–131
Bundick T Jr, Spinella M (2000) Subjective experience, involuntary movement, and posterior alien hand syndrome. J Neurol Neurosurg Psychiatry 68:83–85
Parkin AJ (1996) Explorations in cognitive psychology. Blackwell, New York 20. Brion S, Jedynak CP. Troubles transfert interhemispherique.
Revue Neurol (Paris) 1972;
Refbacks
- There are currently no refbacks.
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
An initiative of The Tamil Nadu Dr M.G.R. Medical University