Structural connectivity in a paediatric case of anarchic hand syndrome

Anna P Basu,Rob J Forsyth,Peter Neal Taylor,Eva Lowther,Andrew M Blamire,Elizabeth O Forsyth

doi:10.1186/s12883-015-0477-z

Abstract

Background“Anarchic hand” is a rare condition characterised by non-volitional, goal-directed movements of one arm. We report a case with analysis of structural and functional connectivity.Case presentationA 15 year old girl developed intermittent symptoms of intermanual conflict or anarchic hand as a result of traumatic brain injury during which she sustained a callosal bleed. Resting-state fMRI and DTI tractography were performed at a stage when symptoms had largely resolved.ConclusionStructural connectivity between homologous superior frontal areas and functional connectivity between homologous posterior cingulate areas were significantly reduced, which may have contributed to causation. Tractography demonstrated new indirect connections between supplementary motor areas via the cerebellum, which we propose contributed to symptom resolution.

Highlights

Background: “Anarchic hand” is a rare condition characterised by non-volitional, goal-directed movements of one arm
We report a case of paroxysmal anarchic hand episodes following traumaticallyacquired callosal injury at the age of fifteen, with analysis of functional and structural connectivity
Functional connectivity was inferred by pairwise examination of the time-domain correlation of the resting-state fMRI BOLD signal between nodes, with results expressed as Mahalanobis distances from the five NKI controls

Summary

Introduction

Background: “Anarchic hand” is a rare condition characterised by non-volitional, goal-directed movements of one arm. Tractography demonstrated new indirect connections between supplementary motor areas via the cerebellum, which we propose contributed to symptom resolution. We report a case of paroxysmal anarchic hand episodes following traumaticallyacquired callosal injury at the age of fifteen, with analysis of functional and structural connectivity.

Results

Conclusion