Alien Hand Syndrome Secondary to Acute Anterior Corpus Callosum Infarction Despite Dual Antiplatelet Therapy: A Case Report

TL;DR

A 50-year-old woman developed alien hand syndrome after a stroke in her corpus callosum, despite being on dual antiplatelet therapy.

Contribution

This case report adds to the understanding of alien hand syndrome as a rare complication of corpus callosum infarction.

Findings

Alien hand syndrome occurred in a patient with an acute corpus callosum infarction.

The patient exhibited intermanual conflict and involuntary left upper extremity movements.

Imaging confirmed ischemic stroke in the right corpus callosum.

Abstract

Alien hand syndrome is an uncommon yet recognized complication of ischemic stroke. It is characterized by involuntary yet seemingly purposeful limb movements that occur without the patient’s volitional control. The syndrome is most commonly associated with injury to the corpus callosum or adjacent medial frontal regions, where interhemispheric motor integration takes place. We report the case of a 50-year-old woman with multiple vascular risk factors who developed an acute infarction of the right corpus callosum. She presented with difficulty initiating movement, confusion, transient visual hallucinations, and involuntary movements of the left upper extremity that interfered with voluntary right-hand tasks, consistent with intermanual conflict. CT head and MRI of the brain confirmed ischemic stroke involving the body, genu, and splenium of the right corpus callosum. She was managed with supportive care with continuation of dual antiplatelet therapy, and subsequent inpatient rehabilitation. This case highlights the importance of recognizing alien hand syndrome as a potential complication of callosal stroke in patients with atypical post-stroke motor behavior.

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