Rinsho Shinkeigaku (Clinical Neurology)

Case Report

Right parietal cerebral infarction with symptoms challenging to differentiate between alien hand sign and sensory ataxia: a case report

Takamichi Kanbayashi, M.D., Ph.D.1), Yudai Uchida, M.D.1), Keiichi Hokkoku, M.D., Ph.D.1) and Masahiro Sonoo, M.D., Ph.D.1)

1)Department of Neurology, Teikyo University School of Medicine

We report the case of a 73-year-old right-handed female with a right parietal cerebral infarction and presented symptoms that were challenging to differentiate between alien hand sign (AHS) and sensory ataxia. She presented to our emergency department with chief complaints of abnormal involuntary movements and a feeling of foreignness on her left upper limb. The first neurological examination revealed left spatial neglect, left-side sensory impairment that included superficial and deep sensations, left limb-kinetic apraxia, and left limb ataxia. Furthermore, her symptoms and complaints had characteristics of AHS that includes a sensation that her left upper limb dose not belong to herself and an abnormal behavior of left hand that is contrary to her own intent. Brain MRI revealed an acute cerebral infarction confined to the right postcentral gyrus. This case highlights that sensory ataxia due to the disturbance of deep sensation might present symptoms similar to AHS. Previous studies suggested the involvement of the disturbance of somatosensory pathway in posterior-variant AHS. Therefore, a precise distinction between AHS and sensory ataxia, especially in posterior-variant AHS, is imperative to avoid confusion regarding the term "alien hand sign."
Full Text of this Article in Japanese PDF (463K)

(CLINICA NEUROL, 58: 287|291, 2018)
key words: alien hand sign, sensory ataxia, cerebral infarction, parietal lobe, postcentral gyrus

(Received: 20-Sep-17)