Assistant Professor of Rehabilitation Medicine Emory University School of Medicine - Grady Campu Atlanta, Georgia, United States
Case Diagnosis: Alien hand syndrome (AHS) is characterized by one hand acting independently of the mind. It has been attributed to lesions in corpus callosum, parietal cortex, anterior cingulate cortex, and/or supplementary motor region. The infrequency of AHSpresents various challenges especially in terms of treatment and prognosis.
Case Description: A 26-year-old transgender woman underwent an emergent decompressive right hemicraniectomy and external ventricular drainage due to a gunshot wound to the right temple. Injuries included right tempoparietal fracture extending to left parietal and right occipital, right frontotemporal subdural hemorrhage, right large parietal intraparenchymal hemorrhage, and mass effect resulting in left subfalcine herniation and medialization of right uncus. Brain MRI also showed evidence of infarct in the corpus callosum. Hospital course was complicated by paroxysmal sympathetic hyperactivity and intermittent agitation. About one weekpost-injury, the patient beganreporting that the left side of her body did not belong to her, and attributed her left hand to a "Michael.” No known Michael reported in patient's life per family. Severe left neglect was noted on physical exam. It was also notable for spontaneous involuntary left arm movement when distracted, but inabilityto hold the limb against gravity when instructed.
Discussions: Neurology suspected the phenomenon to be multifactorial, representing a combination of left-sided neglect, AHS, and delirium. No pharmaceutical intervention was given to the patient. Patient was continued on physical and occupational therapies and cognitive behavioral therapies (CBT). Within a month, the syndrome had resolved.
Conclusions: No pharmaceutical intervention has been proven to be effective with AHS. However,itsrarity continues to limit studies that could be conducted. Therapy techniques that may be helpful include distraction of affected limb, task visualization, mirror therapy, and compensatory strategies.
