Disclosures: Hamza Khalid, DO: No financial relationships or conflicts of interest

Case Description: A 49-year-old right hand dominant male presented to the acute inpatient rehab unit after sustaining an acute bilateral frontoparietal stroke. The patient had mild left sided hemiparesis and some difficulty with executive functioning, but was otherwise intact neurologically. His primary complaint was that his left hand “had a mind of its own” and often times acted independently from the rest of his body.

Setting: Inpatient Rehabilitation Unit

Patient: 49 year-old male Assessment/

Results: CT and MRI of the patient’s brain showed multiple acute infarcts in the medial frontoparietal lobe bilaterally as well as the posterior corpus callosum and splenium regions. The patient stated that during therapy his left hand acted independently and would often “get jealous of his right hand”. While performing ADL’s, the patient noticed his left hand would oppose his right hand’s actions making it difficult to progress in therapy.

Discussion: Alien hand syndrome is a rare condition in which the individual experiences involuntary, yet purposeful action of the affected limb. While the unaffected limb, most often on the patient’s dominant side, remains functionally intact, the affected limb becomes disobedient, at times opposing the actions of the dominant hand. Lesions implicated in causing alien hand syndrome include those in the corpus callosum, posterior parietal cortex, and/or the anterior cingulate cortex. The condition has been reported after corpus callostomy procedures, with brain tumors, aneurysms, and less commonly stroke.

Conclusion: There is no approved treatment for alien hand syndrome and management is solely based on anecdotal reports. Therapeutic modalities have included cognitive behavioral therapy, verbal cues, visualization strategies, and spatial recognition tasks. From a rehab perspective, patients and caregivers should be educated on the patient’s condition and be provided coping strategies to allow the patient time to regain their functional independence. Clinicians should be aware of this rare diagnosis in patients who present with similar symptoms.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/an-out-of-this-world-presentation-of-alien-hand-syndrome/