1
|
Rashwan G, Elagha S, Aldaham T, Thomas L. Alien Hand Syndrome Unveiled in a Patient With Right Middle Cerebral Artery Stroke. Cureus 2024; 16:e52552. [PMID: 38371035 PMCID: PMC10874505 DOI: 10.7759/cureus.52552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 02/20/2024] Open
Abstract
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.
Collapse
Affiliation(s)
- Ghada Rashwan
- Internal Medicine, Rashid Hospital, Dubai Academic Health Corporation, Dubai, ARE
| | - Sara Elagha
- Internal Medicine, Rashid Hospital, Dubai Academic Health Corporation, Dubai, ARE
| | - Tahani Aldaham
- Internal Medicine, Rashid Hospital, Dubai Academic Health Corporation, Dubai, ARE
| | - Liza Thomas
- Internal Medicine, Rashid Hospital, Dubai Academic Health Corporation, Dubai, ARE
| |
Collapse
|
2
|
Ma Y, Liu Y, Yan X, Ouyang Y. Alien hand syndrome, a rare presentation of corpus callosum and cingulate infarction. J Neurol Sci 2023; 452:120739. [PMID: 37536055 DOI: 10.1016/j.jns.2023.120739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/09/2023] [Accepted: 07/23/2023] [Indexed: 08/05/2023]
Abstract
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.
Collapse
Affiliation(s)
- Yiming Ma
- Department of Neurology, The First Hospital of China Medical University, Shenyang City, Liaoning Province, China
| | - Ye Liu
- Department of Neurology, The First Hospital of China Medical University, Shenyang City, Liaoning Province, China
| | - Xuejing Yan
- Department of Neurology, The First Hospital of China Medical University, Shenyang City, Liaoning Province, China
| | - Yi Ouyang
- Department of Neurology, The First Hospital of China Medical University, Shenyang City, Liaoning Province, China.
| |
Collapse
|
3
|
Nguyen H, Phan T, Shadmehr R, Lee SW. Impact of unilateral and bilateral impairments on bimanual force production following stroke. J Neurophysiol 2023; 130:608-618. [PMID: 37529847 DOI: 10.1152/jn.00125.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/03/2023] Open
Abstract
Large bilateral asymmetry and task deficits are typically observed during bimanual actions of stroke survivors. Do these abnormalities originate from unilateral impairments affecting their more-impaired limb, such as weakness and abnormal synergy, or from bilateral impairments such as incoordination of two limbs? To answer this question, 23 subjects including 10 chronic stroke survivors and 13 neurologically intact subjects participated in an experiment where they produced bimanual forces at different hand locations. The force magnitude and directional deviation of the more-impaired arm were measured for unilateral impairments and bimanual coordination across locations for bilateral impairments. Force asymmetry and task error were used to define task performance. Significant unilateral impairments were observed in subjects with stroke; the maximal force capacity of their more-impaired arm was significantly lower than that of their less-impaired arm, with a higher degree of force deviation. However, its force contribution during submaximal tasks was greater than its relative force capacity. Significant bilateral impairments were also observed, as stroke survivors modulated two forces to a larger degree across hand locations but in a less coordinated manner than control subjects did. But only unilateral, not bilateral, impairments explained a significant amount of between-subject variability in force asymmetry across subjects with stroke. Task error, in contrast, was correlated with neither unilateral nor bilateral impairments. Our results suggest that unilateral impairments of the more-impaired arm of stroke survivors mainly contribute to its reduced recruitment, but that the degree of its participation in bimanual task may be greater than their capacity as they attempt to achieve symmetry.NEW & NOTEWORTHY We studied how unilateral and bilateral impairments in stroke survivors affect their bimanual task performance. Unilateral impairments of the more-impaired limb, both weakness and loss of directional control, mainly contribute to bimanual asymmetry, but stroke survivors generally produce higher force with their more-impaired limb than their relative capacity. Bilateral force coordination was significantly impaired in stroke survivors, but its degree of impairment was not related to their unilateral impairments.
Collapse
Affiliation(s)
- Hien Nguyen
- Department of Biomedical Engineering, Catholic University of America, Washington, District of Columbia, United States
- Center for Applied Biomechanics and Rehabilitation Research, MedStar National Rehabilitation Hospital, Washington, District of Columbia, United States
| | - Thanh Phan
- Department of Biomedical Engineering, Catholic University of America, Washington, District of Columbia, United States
- Center for Applied Biomechanics and Rehabilitation Research, MedStar National Rehabilitation Hospital, Washington, District of Columbia, United States
| | - Reza Shadmehr
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, United States
| | - Sang Wook Lee
- Department of Biomedical Engineering, Catholic University of America, Washington, District of Columbia, United States
- Center for Applied Biomechanics and Rehabilitation Research, MedStar National Rehabilitation Hospital, Washington, District of Columbia, United States
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| |
Collapse
|
4
|
Lamp G, Sola Molina RM, Hugrass L, Beaton R, Crewther D, Crewther SG. Kinematic Studies of the Go/No-Go Task as a Dynamic Sensorimotor Inhibition Task for Assessment of Motor and Executive Function in Stroke Patients: An Exploratory Study in a Neurotypical Sample. Brain Sci 2022; 12:1581. [PMID: 36421905 PMCID: PMC9688448 DOI: 10.3390/brainsci12111581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/25/2022] [Accepted: 11/12/2022] [Indexed: 08/30/2023] Open
Abstract
Inhibition of reaching and grasping actions as an element of cognitive control and executive function is a vital component of sensorimotor behaviour that is often impaired in patients who have lost sensorimotor function following a stroke. To date, there are few kinematic studies detailing the fine spatial and temporal upper limb movements associated with the millisecond temporal trajectory of correct and incorrect responses to visually driven Go/No-Go reaching and grasping tasks. Therefore, we aimed to refine the behavioural measurement of correct and incorrect inhibitory motor responses in a Go/No-Go task for future quantification and personalized rehabilitation in older populations and those with acquired motor disorders, such as stroke. An exploratory study mapping the kinematic profiles of hand movements in neurotypical participants utilizing such a task was conducted using high-speed biological motion capture cameras, revealing both within and between subject differences in a sample of healthy participants. These kinematic profiles and differences are discussed in the context of better assessment of sensorimotor function impairment in stroke survivors.
Collapse
Affiliation(s)
- Gemma Lamp
- School of Psychology and Public Health, La Trobe University, Bundoora, VIC 3086, Australia
| | - Rosa Maria Sola Molina
- School of Psychology and Public Health, La Trobe University, Bundoora, VIC 3086, Australia
| | - Laila Hugrass
- School of Psychology and Public Health, La Trobe University, Bundoora, VIC 3086, Australia
| | - Russell Beaton
- School of Psychology and Public Health, La Trobe University, Bundoora, VIC 3086, Australia
| | - David Crewther
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC 3022, Australia
| | - Sheila Gillard Crewther
- School of Psychology and Public Health, La Trobe University, Bundoora, VIC 3086, Australia
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC 3022, Australia
| |
Collapse
|
5
|
Mark VW. Functional neurological disorder: Extending the diagnosis to other disorders, and proposing an alternate disease term—Attentionally-modifiable disorder. NeuroRehabilitation 2022; 50:179-207. [DOI: 10.3233/nre-228003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: The term “functional neurological disorder,” or “FND,” applies to disorders whose occurrence of neurological symptoms fluctuate with the patient’s attention to them. However, many other disorders that are not called “FND” nonetheless can also follow this pattern. Consequently, guidelines are unclear for diagnosing “FND.” OBJECTIVE: To review the neurological conditions that follow this pattern, but which have not so far been termed “FND,” to understand their overlap with conditions that have been termed “FND,” and to discuss the rationale for why FND has not been diagnosed for them. METHOD: A systematic review of the PubMed literature registry using the terms “fluctuation,” “inconsistency,” or “attention” did not yield much in the way of these candidate disorders. Consequently, this review instead relied on the author’s personal library of peer-reviewed studies of disorders that have resembled FND but which were not termed this way, due to his longstanding interest in this problem. Consequently, this approach was not systematic and was subjective regarding disease inclusion. RESULTS: This review identified numerous, diverse conditions that generally involve fluctuating neurological symptoms that can vary with the person’s attention to them, but which have not been called “FND.” The literature was unclear for reasons for not referring to “FND” in these instances. CONCLUSION: Most likely because of historical biases, the use of the term “FND” has been unnecessarily restricted. Because at its core FND is an attentionally-influenced disorder that can respond well to behavioral treatments, the field of neurological rehabilitation could benefit by extending the range of conditions that could be considered as “FND” and referred for similar behavioral treatments. Because the term “FND” has been viewed unfavorably by some patients and clinical practitioners and whose treatment is not implied, the alternative term attentionally-modifiable disorder is proposed.
Collapse
Affiliation(s)
- Victor W. Mark
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
6
|
Powell C, Rosenblatt L, Bontempo L, Dezman Z. 57-year-old Female with Unusual Left-arm Movements. Clin Pract Cases Emerg Med 2022; 6:1-7. [PMID: 35254237 PMCID: PMC8900599 DOI: 10.5811/cpcem.2022.2.55676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/04/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction A 57-year-old, right-hand dominant female presented to the emergency department striking herself with her left hand. Case Presentation The astute medical staff looked beyond a behavioral health etiology. A detailed history, physical examination, and workup reveals the fascinating final diagnosis. Discussion This case takes the reader through the differential diagnosis and systematic workup of uncontrolled limb movements with discussion of the studies which ultimately led to this patient’s diagnosis.
Collapse
Affiliation(s)
| | - Lauren Rosenblatt
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - Laura Bontempo
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - Zachary Dezman
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland; University of Maryland, Baltimore, Department of Epidemiology and Public Health, Baltimore, Maryland
| |
Collapse
|
7
|
Brust JC, Chamorro A. Anterior Cerebral Artery Disease. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00023-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
8
|
Liu P, Yuan Y, Zhang N, Liu X, Yu L, Luo B. Mirror Movements in Acquired Neurological Disorders: A Mini-Review. Front Neurol 2021; 12:736115. [PMID: 34616356 PMCID: PMC8488104 DOI: 10.3389/fneur.2021.736115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 08/17/2021] [Indexed: 11/13/2022] Open
Abstract
Mirror movements (MMs) are specifically defined as involuntary movements occurring on one side of homologous muscles when performing unilateral movements with the contralateral limb. MMs have been considered a kind of soft neurological signs, and the persistence or reappearance of MMs in adults is usually pathologic. In addition to some congenital syndrome, MMs have been also described in age-related neurological diseases including pyramidal system diseases (e.g., stroke, amyotrophic lateral sclerosis) and extrapyramidal disorders (e.g., Parkinson's disease, essential tremor). With the advances in instrumentation and detection means, subtle or subclinical MMs have been deeply studied. Furthermore, the underlying mechanism is also being further elucidated. In this mini-review, we firstly discuss the MM examination means, and then review the literature regarding MMs in individuals with acquired neurological disorders, in order to further understand the pathogenesis of MMs.
Collapse
Affiliation(s)
- Ping Liu
- Department of Neurology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuan Yuan
- Department of Neurology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ning Zhang
- Department of Neurology, Pujiang People's Hospital, Jinhua, China
| | - Xiaoyan Liu
- Department of Neurology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lihua Yu
- Department of Neurology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Benyan Luo
- Department of Neurology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
9
|
Dr. Strangelove demystified: Disconnection of hand and language dominance explains alien-hand syndrome after corpus callosotomy. Seizure 2021; 86:147-151. [PMID: 33621826 DOI: 10.1016/j.seizure.2021.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Alien hand syndrome (AHS) is a disabling condition in which one hand behaves in a way that the person finds "alien". This feeling of alienation is related to the occurrence of movements of the respective hand performed without or against conscious intention. Most information on AHS stems from single case observations in patients with frontal, callosal, or parietal brain damage. METHODS Retrospective analysis of distinctive clinical features of three out of 18 epilepsy patients who developed AHS with antagonistic movements of the left hand after corpus callosotomy (CC) (one anterior, two complete) for the control of epileptic seizures, particularly epileptic drop attacks (EDA). RESULTS Remarkably, these three patients, two men and one woman, displayed atypical language dominance with a bilateral, left more than right hemisphere language representation in intracarotidal amobarbital testing before surgery. The overall additional distinctive feature of the target patients was genuine left-handedness, with writing retrained to right-handedness in two patients. After surgery the left hands became alien. The problem was permanent, despite strategies for compensation. CONCLUSION From this observation we suggest that under the conditions of dissociation of language and motor dominance, loss of both intentional control of contralateral action and physiological inhibition of antagonistic movements lead to post-callosotomy alien-hand-like motor phenomena. The dissociation pattern posing this risk seems rare but needs to be considered when evaluating candidates for callosotomy.
Collapse
|
10
|
More than Just a "Motor": Recent Surprises from the Frontal Cortex. J Neurosci 2019; 38:9402-9413. [PMID: 30381432 DOI: 10.1523/jneurosci.1671-18.2018] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/14/2018] [Accepted: 09/17/2018] [Indexed: 12/31/2022] Open
Abstract
Motor and premotor cortices are crucial for the control of movements. However, we still know little about how these areas contribute to higher-order motor control, such as deciding which movements to make and when to make them. Here we focus on rodent studies and review recent findings, which suggest that-in addition to motor control-neurons in motor cortices play a role in sensory integration, behavioral strategizing, working memory, and decision-making. We suggest that these seemingly disparate functions may subserve an evolutionarily conserved role in sensorimotor cognition and that further study of rodent motor cortices could make a major contribution to our understanding of the evolution and function of the mammalian frontal cortex.
Collapse
|
11
|
Kojović M, Bhatia KP. Bringing order to higher order motor disorders. J Neurol 2018; 266:797-805. [PMID: 30027322 DOI: 10.1007/s00415-018-8974-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/06/2018] [Accepted: 07/07/2018] [Indexed: 11/26/2022]
Abstract
Majority of movements in everyday situations are complex and involve volition, planning of the movement and selection of the motor programme, all occurring before movement execution. Higher order motor disorders may be defined as abnormal motor behaviours resulting from disruption of any of the cortical processes that precede execution of the motor act. They are common in patients with neurodegenerative disorders, psychiatric diseases and structural brain lesions. These abnormal behaviours may be overlooked in the clinic, unless specifically evoked by the examiner. We discuss clinical and pathophysiological aspects of higher order motor disorders including: (1) disorders of disinhibition, such as grasp reflex and grasping behaviour, utilisation and imitation behaviour, motor preservations and paratonia; (2) disorders of motor intention such as motor neglect and motor impersistence; (3) alien limb syndrome; and (4) motor overflow phenomena, such as mirror movements and synkinesias. A video illustration of each phenomenon is provided. We place the findings from recent neurophysiological studies within the framework of theories of motor control to provide better insight into pathophysiology of different disorders.
Collapse
Affiliation(s)
- Maja Kojović
- Department of Neurology, University Medical Centre Ljubljana, Zaloška 2, 1000, Ljubljana, Slovenia.
| | - Kailash P Bhatia
- Institute of Neurology, University College London, 7 Queen Square, London, WC1N 3BG, UK
| |
Collapse
|
12
|
Abstract
The motor cortex is a large frontal structure in the cerebral cortex of eutherian mammals. A vast array of evidence implicates the motor cortex in the volitional control of motor output, but how does the motor cortex exert this 'control'? Historically, ideas regarding motor cortex function have been shaped by the discovery of cortical 'motor maps' - that is, ordered representations of stimulation-evoked movements in anaesthetized animals. Volitional control, however, entails the initiation of movements and the ability to suppress undesired movements. In this article, we highlight classic and recent findings that emphasize that motor cortex neurons have a role in both processes.
Collapse
|
13
|
Abstract
Alien hand syndrome (AHS) is a rare disorder of involuntary limb movement together with a sense of loss of limb ownership. It most commonly affects the hand, but can occur in the leg. The anterior (frontal, callosal) and posterior variants are recognized, with distinguishing clinical features and anatomical lesions. Initial descriptions were attributed to stroke and neurosurgical operations, but neurodegenerative causes are now recognized as most common. Structural and functional imaging and clinical studies have implicated the supplementary motor area, pre-supplementary motor area, and their network connections in the frontal variant of AHS, and the inferior parietal lobule and connections in the posterior variant. Several theories are proposed to explain the pathophysiology. Herein, we review the literature to update advances in the understanding of the classification, pathophysiology, etiology, and treatment of AHS.
Collapse
Affiliation(s)
- Anhar Hassan
- Department of Neurology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Keith A Josephs
- Department of Neurology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| |
Collapse
|
14
|
Schaefer M, Denke C, Apostolova I, Heinze HJ, Galazky I. A Case of Right Alien Hand Syndrome Coexisting with Right-Sided Tactile Extinction. Front Hum Neurosci 2016; 10:105. [PMID: 27014036 PMCID: PMC4789496 DOI: 10.3389/fnhum.2016.00105] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 02/25/2016] [Indexed: 11/13/2022] Open
Abstract
The alien hand syndrome (AHS) is a fascinating movement disorder. Patients with AHS experience one of their limbs as alien, which acts autonomously and performs meaningful movements without being guided by the intention of the patient. Here, we report a case of a 74-years old lady diagnosed with an atypical Parkinson syndrome by possible corticobasal degeneration. The patient stated that she could not control her right hand and that she felt like this hand had her own life. We tested the patient for ownership illusions of the hands and general tactile processing. Results revealed that when blindfolded, the patient recognized touch to her alien hand only if it was presented separated from touch to the other hand (bilateral asynchronous touch). Delivering touch synchronously to both the alien and the healthy hand resulted in failure of recognizing touch to the alien hand (bilateral synchronous touch). Thus, AHS here co-existed with right-sided tactile extinction and is one of only very few cases in which the alien hand was felt on the right side. We discuss the results in the light of recent research on AHS.
Collapse
Affiliation(s)
- Michael Schaefer
- Department of Neurology, Otto-von-Guericke University Magdeburg Magdeburg, Germany
| | - Claudia Denke
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin Berlin, Germany
| | - Ivayla Apostolova
- Department of Radiology, Otto-von-Guericke University Magdeburg Magdeburg, Germany
| | - Hans-Jochen Heinze
- Department of Neurology, Otto-von-Guericke University Magdeburg Magdeburg, Germany
| | - Imke Galazky
- Department of Neurology, Otto-von-Guericke University Magdeburg Magdeburg, Germany
| |
Collapse
|
15
|
Brust JC, Chamorro A. Anterior Cerebral Artery Disease. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00023-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
16
|
Brugger F, Galovic M, Weder BJ, Kägi G. Supplementary Motor Complex and Disturbed Motor Control - a Retrospective Clinical and Lesion Analysis of Patients after Anterior Cerebral Artery Stroke. Front Neurol 2015; 6:209. [PMID: 26528234 PMCID: PMC4600920 DOI: 10.3389/fneur.2015.00209] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 09/14/2015] [Indexed: 12/19/2022] Open
Abstract
Background Both the supplementary motor complex (SMC), consisting of the supplementary motor area (SMA) proper, the pre-SMA, and the supplementary eye field, and the rostral cingulate cortex are supplied by the anterior cerebral artery (ACA) and are involved in higher motor control. The Bereitschaftspotential (BP) originates from the SMC and reflects cognitive preparation processes before volitional movements. ACA strokes may lead to impaired motor control in the absence of limb weakness and evoke an alien hand syndrome (AHS) in its extreme form. Aim To characterize the clinical spectrum of disturbed motor control after ACA strokes, including signs attributable to AHS and to identify the underlying neuroanatomical correlates. Methods A clinical assessment focusing on signs of disturbed motor control including intermanual conflict (i.e., bilateral hand movements directed at opposite purposes), lack of self-initiated movements, exaggerated grasping, motor perseverations, mirror movements, and gait apraxia was performed. Symptoms were grouped into (A) AHS-specific and (B) non-AHS-specific signs of upper limbs, and (C) gait apraxia. Lesion summation mapping was applied to the patients’ MRI or CT scans to reveal associated lesion patterns. The BP was recorded in two patients. Results Ten patients with ACA strokes (nine unilateral, one bilateral; mean age: 74.2 years; median NIH-SS at admission: 13.0) were included in this case series. In the acute stage, all cases had marked difficulties to perform volitional hand movements, while movements in response to external stimuli were preserved. In the chronic stage (median follow-up: 83.5 days) initiation of voluntary movements improved, although all patients showed persistent signs of disturbed motor control. Impaired motor control is predominantly associated with damaged voxels within the SMC and the anterior and medial cingulate cortex, while lesions within the pre-SMA are specifically related to AHS. No BP was detected over the damaged hemisphere. Conclusion ACA strokes involving the premotor cortices, particularly the pre-SMA, are associated with AHS-specific signs. In the acute phase, motor behavior is characterized by the inability to carry out self-initiated movements. Motor control deficits may persist to a variable degree beyond the acute phase. Alterations of the BP point to an underlying SMC dysfunction in AHS.
Collapse
Affiliation(s)
- Florian Brugger
- Klinik für Neurologie, Kantonsspital St. Gallen , St. Gallen , Switzerland ; Sobell Department of Motor Neuroscience and Movement Disorders, University College London , London , UK
| | - Marian Galovic
- Klinik für Neurologie, Kantonsspital St. Gallen , St. Gallen , Switzerland
| | - Bruno J Weder
- Support Center of Advanced Neuroimaging, Inselspital , Bern , Switzerland
| | - Georg Kägi
- Klinik für Neurologie, Kantonsspital St. Gallen , St. Gallen , Switzerland
| |
Collapse
|
17
|
Sarva H, Deik A, Severt WL. Pathophysiology and treatment of alien hand syndrome. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2014; 4:241. [PMID: 25506043 PMCID: PMC4261226 DOI: 10.7916/d8vx0f48] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 10/21/2014] [Indexed: 12/01/2022]
Abstract
Background Alien hand syndrome (AHS) is a disorder of involuntary, yet purposeful,
hand movements that may be accompanied by agnosia, aphasia, weakness, or sensory
loss. We herein review the most reported cases, current understanding of the
pathophysiology, and treatments. Methods We performed a PubMed search in July of 2014 using the phrases “alien hand
syndrome,” “alien hand syndrome pathophysiology,” “alien
hand syndrome treatment,” and “anarchic hand syndrome.” The
search yielded 141 papers (reviews, case reports, case series, and clinical
studies), of which we reviewed 109. Non-English reports without
English abstracts were excluded. Results Accumulating evidence indicates that there are three AHS variants: frontal,
callosal, and posterior. Patients may demonstrate symptoms of multiple types;
there is a lack of correlation between phenomenology and neuroimaging findings.
Most pathologic and functional imaging studies suggest network disruption causing
loss of inhibition as the likely cause. Successful interventions include botulinum
toxin injections, clonazepam, visuospatial coaching techniques, distracting the
affected hand, and cognitive behavioral therapy. Discussion The available literature suggests that overlap between AHS subtypes is common. The
evidence for effective treatments remains anecdotal, and, given the rarity of AHS,
the possibility of performing randomized, placebo-controlled trials seems
unlikely. As with many other interventions for movement disorders, identifying the
specific functional impairments caused by AHS may provide the best guidance
towards individualized supportive care.
Collapse
Affiliation(s)
- Harini Sarva
- Department of Neurology, Maimonides Medical Center, New York, NY, USA
| | - Andres Deik
- Parkinson Disease and Movement Disorders Center, Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | | |
Collapse
|
18
|
Gerrish AC, Thomas AG, Dineen RA. Brain white matter tracts: functional anatomy and clinical relevance. Semin Ultrasound CT MR 2014; 35:432-44. [PMID: 25217297 DOI: 10.1053/j.sult.2014.06.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Diffusion tensor imaging is increasingly available on clinical magnetic resonance scanners and can be acquired in a relatively short time. There has been an explosion of applications in the research field but the use to the practicing radiologist may seem obscure. This paper aims to highlight how diffusion tensor imaging can be used to prompt a dedicated neuroanatomical search for white matter lesions in clinical presentations relating to motor, sensory, language, and visuospatial deficits. The enhanced depiction of white matter tracts in the temporal stem is also highlighted, which is a region of importance in epilepsy surgery planning.
Collapse
Affiliation(s)
- Amy C Gerrish
- Department of Imaging, Leicester Royal Infirmary, Leicester, UK
| | - Adam G Thomas
- Department of Imaging, Leicester Royal Infirmary, Leicester, UK; Department of Neuroradiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - Robert A Dineen
- Department of Neuroradiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK; Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| |
Collapse
|
19
|
Romano D, Sedda A, Dell'aquila R, Dalla Costa D, Beretta G, Maravita A, Bottini G. Controlling the alien hand through the mirror box. A single case study of alien hand syndrome. Neurocase 2014; 20:307-16. [PMID: 23557374 DOI: 10.1080/13554794.2013.770882] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Disruption of motor control in the alien hand syndrome might result from a dissociation between intentions and sensory information. We hypothesized that voluntary motor control in this condition could improve by restoring the congruency between motor intentions and visual feedback. The present study shows that, in one patient with right alien hand syndrome, the use of a mirror box paradigm improved motor speed. We speculate that the visual feedback provided by the mirror increases the sense of congruence between intention and sensory feedback, leading to motor improvement.
Collapse
Affiliation(s)
- D Romano
- a Dipartimento di Psicologia , Università degli studi di Milano Bicocca , Milano , Italy
| | | | | | | | | | | | | |
Collapse
|
20
|
Nowak DA, Bösl K, Lüdemann-Podubecka J, Gdynia HJ, Ponfick M. Recovery and outcome of frontal alien hand syndrome after anterior cerebral artery stroke. J Neurol Sci 2014; 338:203-6. [DOI: 10.1016/j.jns.2014.01.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 01/03/2014] [Accepted: 01/05/2014] [Indexed: 11/25/2022]
|
21
|
Schaefer M, Heinze HJ, Galazky I. Waking up the alien hand: rubber hand illusion interacts with alien hand syndrome. Neurocase 2013; 19:371-6. [PMID: 22554115 DOI: 10.1080/13554794.2012.667132] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
It has been shown that combinations of visual, tactile, and proprioceptive manipulations in healthy subjects may elicit illusory feelings of embodiment (the rubber hand illusion and the somatic rubber hand illusion). We report a case of alien hand syndrome in which the alien hand interacted with the somatic rubber hand illusion to provoke a very strong movement of the alien hand. This effect could be reliably replicated at every application of the experimental procedure. Thus, the illusion seemed to wake up the alien hand. The results demonstrate that the alien hand syndrome can be affected by experimentally induced bodily illusions, which are based on the manipulation of touch and proprioceptive information.
Collapse
Affiliation(s)
- Michael Schaefer
- Department of Neurology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
| | | | | |
Collapse
|
22
|
Bakheit AMO, Brennan A, Gan P, Green H, Roberts S. Anarchic hand syndrome following resection of a frontal lobe tumor. Neurocase 2013; 19:36-40. [PMID: 22494197 DOI: 10.1080/13554794.2011.654213] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Anarchic hand syndrome (AHS) is a rare disorder characterized by unwilled, but seemingly purposeful movements of the affected upper limb which are perceived by the patients not to be under their control. It often interferes with goal-directed movements and bimanual tasks. At present there is no effective method of treatment of AHS. We report here a case of AHS following resection of a frontal lobe tumor and describe its effects on the patient's functional activities. The patient used avoidance behavior and mental concentration to overcome the disabling effect of AHS. These strategies appear to be useful in the management of AHS.
Collapse
Affiliation(s)
- A M O Bakheit
- Moseley Hall Hospital, Alcester Road, Birmingham, UK.
| | | | | | | | | |
Collapse
|
23
|
Verleger R, Binkofski F, Friedrich M, Sedlmeier P, Kömpf D. Anarchic-hand syndrome: ERP reflections of lost control over the right hemisphere. Brain Cogn 2011; 77:138-50. [DOI: 10.1016/j.bandc.2011.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 02/07/2011] [Accepted: 05/11/2011] [Indexed: 11/17/2022]
|
24
|
Schaefer M, Heinze HJ, Galazky I. Alien hand syndrome: neural correlates of movements without conscious will. PLoS One 2010; 5:e15010. [PMID: 21179436 PMCID: PMC3001471 DOI: 10.1371/journal.pone.0015010] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 10/05/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The alien hand syndrome is a striking phenomenon characterized by purposeful and autonomous movements that are not voluntarily initiated. This study aimed to examine neural correlates of this rare neurological disorder in a patient with corticobasal degeneration and alien hand syndrome of the left hand. METHODOLOGY/PRINCIPAL FINDINGS We employed functional magnetic resonance imaging to investigate brain responses associated with unwanted movements in a case study. Results revealed that alien hand movements involved a network of brain activations including the primary motor cortex, premotor cortex, precuneus, and right inferior frontal gyrus. Conscious and voluntary movements of the alien hand elicited a similar network of brain responses but lacked an activation of the inferior frontal gyrus. The results demonstrate that alien and unwanted movements may engage similar brain networks than voluntary movements, but also imply different functional contributions of prefrontal areas. Since the inferior frontal gyrus was uniquely activated during alien movements, the results provide further support for a specific role of this brain region in inhibitory control over involuntary motor responses. CONCLUSIONS/SIGNIFICANCE We discuss the outcome of this study as providing evidence for a distributed neural network associated with unwanted movements in alien hand syndrome, including brain regions known to be related to movement execution and planning as well as areas that have been linked to inhibition control (inferior frontal gyrus) and experience of agency (precuneus).
Collapse
Affiliation(s)
- Michael Schaefer
- Department of Neurology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
| | | | | |
Collapse
|
25
|
Kloesel B, Czarnecki K, Muir JJ, Keller AS. Sequelae of a left-sided parietal stroke: posterior alien hand syndrome. Neurocase 2010; 16:488-93. [PMID: 20824573 DOI: 10.1080/13554794.2010.497154] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Posterior alien hand syndrome is a new addition to a poorly understood group of movement disorders. Historically, anatomical lesions causing uncontrolled limb movement and a feeling of foreignness were found to be located in the corpus callosum or frontal lobe. Recent case reports, however, demonstrate the typical symptoms of alien hand syndrome with lesions located in the parietal/occipital lobes. Disturbance of normal function in these regions tends to produce less complex motor activity, such as hand levitation, along with a sensory component characterized by feeling of estrangement. We discuss a patient who presented with unusual symptoms following an outpatient procedure and was found to have posterior alien hand syndrome.
Collapse
Affiliation(s)
- Benjamin Kloesel
- Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
| | | | | | | |
Collapse
|
26
|
Seidel EM, Eickhoff SB, Kellermann T, Schneider F, Gur RC, Habel U, Derntl B. Who is to blame? Neural correlates of causal attribution in social situations. Soc Neurosci 2009; 5:335-50. [PMID: 20162490 DOI: 10.1080/17470911003615997] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In everyday life causal attribution is important in order to structure the complex world, provide explanations for events and to understand why our environment interacts with us in a particular way. This study used functional magnetic resonance imaging (fMRI) in 30 healthy subjects to separate the neural correlates of self vs. external responsibility for social events and explore the neural basis of self-serving attributions (internal attributions of positive events and external attributions of negative events). We presented short sentences describing positive and negative social events and asked participants to imagine the event, to decide the main cause and assign it to one of the categories (internal vs. external). FMRI data were analyzed using a 2 x 2 factorial design with the factors emotional valence and attribution. Internal compared to external attribution revealed activations along the right temporoparietal junction (TPJ). The reverse contrast showed a left lateralized network mainly involving the TPJ, the precuneus and the superior/medial frontal gyrus. These results confirmed the involvement of a fronto-temporoparietal network in differentiating self and external responsibility. Analysis of the self-serving bias yielded activation in the dorsal anterior cingulate and in the dorsal striatum, suggesting a rewarding value of these attributions.
Collapse
Affiliation(s)
- Eva-Maria Seidel
- Department of Psychiatry and Psychotherapy, RWTH Aachen University, Aachen, Germany.
| | | | | | | | | | | | | |
Collapse
|
27
|
Spector AR, Freeman WD, Cheshire WP. The Stroke that Struck Back: An Unusual Alien Hand Presentation. J Stroke Cerebrovasc Dis 2009; 18:72-3. [DOI: 10.1016/j.jstrokecerebrovasdis.2008.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Revised: 07/17/2008] [Accepted: 08/06/2008] [Indexed: 10/21/2022] Open
|
28
|
Fontenelle LF, Mendlowicz MV. The Wernicke-Kleist-Leonhard "short-circuiting": a missing link between attention deficit hyperactivity disorder, Tourette syndrome, and obsessive-compulsive disorder? Med Hypotheses 2008; 71:418-25. [PMID: 18511213 DOI: 10.1016/j.mehy.2008.03.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Revised: 02/18/2008] [Accepted: 03/27/2008] [Indexed: 11/16/2022]
Abstract
According to the Wernicke-Kleist-Leonhard (WKL) School of Psychiatry, human actions could be categorized into spontaneous, expressive, reflex, and reactive. The so-called short-circuit movements represent a pathological exaggeration of immediate reactions to sensory impressions, such as sudden or threatening stimuli. "Short-circuiting" was deemed of utmost importance for the diagnoses of several WKL endogenous psychoses, such as hyperkinetic motility psychosis, periodic catatonia, and proskinetic catatonia. We suggest that short-circuit movements may be an under-reported behavioral phenotype that may cut across different phenotypes of non-psychotic DSM-IV-TR disorders, such as attention deficit hyperactivity disorder (ADHD), Tourette's syndrome (TS), and obsessive-compulsive disorder (OCD). Several features of a neuropsychiatric syndrome seen in the coarse frontal lobe disease ("complex psychomotor release phenomena") may provide a neurological working model for "short-circuiting" in ADHD, TS, and OCD. Further, short-circuit movements may be associated with different degrees of serotonergic, dopaminergic, and glutamatergic dysfunctions. Indeed, although there are a growing number of studies reporting successful treatment of short-circuit movements with topiramate and other glutamatergic antagonists, treatment response to drugs based on serotonergic or dopaminergic mechanisms of action is more uncertain and, sometimes, detrimental, leading to an aggravation of pathological behavior. A resurgence of the interest on the descriptive psychopathology of the WKL short-circuit movements could provide a new conceptual framework for the studies on the neurobiology of volitional disorders.
Collapse
Affiliation(s)
- Leonardo F Fontenelle
- Anxiety and Depression Research Program, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro-RJ, Brazil.
| | | |
Collapse
|