Abstract
Background: Alien hand syndrome [AHS] is a rare and ill-defined neurological disorder. It produces complex, goal-directed motion of one hand that is involuntarily instigated. This syndrome characteristically arises after brain trauma, brain surgery, stroke or encephalitis. We describe a case of AHS in a patient who had a previous episode of subarachnoid hemorrhage affecting the left frontal lobe and corpus callosum. Case presentation: An 84-year-old woman presented to the emergency department complaining of headaches and several episodes of her left arm moving as if it was groping around trying to grab at her own body. A computed tomography scan of the head demonstrated an acute left superior frontal hemorrhage with compression of the corpus callosum. Transcranial Doppler report showed no significant abnormality in the insonated vessels. After being stabilized for the acute bleed, she was treated with clonazepam 0.5 mgat night for the uncontrolled hand movements. Her movements resolved by her next month follow up. The diagnosis of AHS was made based on her clinical presentation, characterization of the movement and localization correlating with findings in neuroimaging. Conclusion: We document a rare neurologic disorder seen in patients presenting with a history of previous strokes and a typical description of involuntary and unintentional, uncontrolled unilateral arm movements with repetitive grasping. The present case has a combination of frontal and callosal lesions. These findings appear to support a potential destruction leading to the rare syndrome.
Highlights
Alien hand syndrome [AHS] is a loosely defined collection of symptoms characterized by involuntary movement of an upper limb in concurrence with the experience of separation from or exemplification of the actions of the limb itself
We describe a patient who presented with subarachnoid hemorrhage involving the left medial aspect of the frontal lobe and caused the patient to present with headache and unconscious left hand movements consistent with AHS
Case presentation An 84-year-old African-American right hand dominant woman presented to the emergency department complaining of headache and episodes of uncontrollable left hand movements
Summary
Alien hand syndrome [AHS] is a loosely defined collection of symptoms characterized by involuntary movement of an upper limb in concurrence with the experience of separation from or exemplification of the actions of the limb itself. A Transcranial Doppler (TCD) study was done due to the clinical history of subarachnoid hemorrhage, and showed a normal direction of blood flow with mean flow velocities and spectral waveform Her past medical history included chronic anemia, hypertension, previous intracranial hemorrhage, glaucoma, breast cancer (in remission) and cataracts. Patient with left hemispheric brain tumor invading the corpus callosum resulted in involuntary grasping and dropping of objects with the contralateral hand as described by Van Vleuten[9]. She presented to the clinic two weeks later with continued complaints of the left hand movements At this point, the patient was expressing significant frustration and asked for assistance for these “Devilish movements”. At her one-month follow-up, the patient was pleased to report that her symptoms had decreased significantly and had last occurred about one week prior to her clinic visit
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