Alien hand syndrome following corpus callosum infarction: A case report and review of the literature

Abstract

Alien hand syndrome (AHS) is characterized by involuntary and autonomous activity of the affected limbs, and consists of the frontal, callosal and posterior AHS variants. The callosal subtype, resulting from damage to the corpus callosum, frequently features intermanual conflict. However, infarction of the corpus callosum is rare due to abundant blood supply. The present study reported a case of AHS (callosal subtype, in the right hand) caused by callosal infarction. Infarction of the left corpus callosum was confirmed with magnetic resonance imaging. In addition, magnetic resonance angiography and digital subtraction angiography examinations revealed multiple lesions in the feeding arteries. Subsequent to antiplatelet therapy for 2 weeks following admission, the patient gradually recovered. Furthermore, the current study reviewed 31 previously reported cases of AHS following callosal infarction in the literature.

Keywords: alien hand syndrome; corpus callosum; infarction.

Figure 1.

Multi-modal brain magnetic resonance imaging (MRI). (A and B) T1 hypo-intensity in the splenium of the left corpus callosum. (C and D) T1 hypo-intensity in the body of the left corpus callosum. (E and F) T2 hyper-intensity in the splenium of the left corpus callosum. (G and H) T2 hyper-intensity in body of the left corpus callosum. (I-L) Axial diffusion weighted imaging of MRI. (I and J) Diffusion weighted imaging showed high signal intensity in the splenium of the corpus callosum. (K and L) Diffusion weighted imaging demonstrated high signal intensity in the body of the corpus callosum. All these confirm the infarction of left corpus callosum.

Figure 2.

Brain MRA. (A) MRA revealed extensive stenosis in basilar artery. (B) Lateral view of MRA showed multiple severe stenosis of basilar artery. MRA, magnetic resonance angiography.

Figure 3.

Cerebral digital subtraction angiography. (A) Angiography of the right internal carotid artery showed opening of the posterior communicating artery in the right cerebral artery. (B) Angiography of the left internal carotid artery revealed opening of the posterior communicating artery in the left cerebral artery, while the bilateral posterior cerebral artery and basilar artery apex are also visualized. (C) Faint visualization of the left anterior cerebral artery and pericallosal artery are shown. (D) Fine right vertebral artery and occlusion of distal segment of the intracranial branch in the right vertebral artery are shown. (E) Fine and occlusive intracranial branch of the left vertebral and basilar arteries were visualized, with ~90% stenosis observed.