Disclosures: Victor S. Chukwueke, MD:

Case Diagnosis: Posterior alien hand syndrome with ipsilateral synkinesis of wrist-to-foot and contralateral synkinesis of bilateral hands.

Case Description: A 77-year-old practicing plastic surgeon presented with left hemiparesis and left arm numbness due to right posterior cerebral artery (PCA) distribution ischemic stroke, primarily in the temporo-occipital lobes with restricted diffusion in the right splenium of the corpus collosum – later developed left frontal intraparenchymal hemorrhage after tPA administration requiring reversal. As tPA was administered, he was noted to have erratic choreiform movements of the left arm. During inpatient rehabilitation noted to have poor volitional control of his left arm, majority extension based, with subjective feeling that his hand was not his own – consistent with diagnosis of Alien Hand Syndrome (AHS). Associated with left elbow extensor spasticity (MAS 1+) and left central poststroke pain syndrome. At 4 weeks post-stroke, patient was noted to have improved coordination with less abnormal movements of his left arm. At 5 weeks, noted to have ipsilateral synkinesis of his left wrist coordinating with left ankle, and contralateral synkinesis of left hand to right hand.

Setting: Inpatient rehabilitation.Assessment/

Results: Presentation of posterior AHS due to non-dominant PCA ischemic stroke after tPA administration.

Discussion: AHS has a multitude of etiologies and is divided into 3 main variants including the frontal, callosal, and posterior subtypes. The involuntary movements in posterior AHS is likely contributed by sensory ataxia, poor proprioceptive awareness, and hemineglect. The left hand is most commonly affected and prognosis for most cases is poor.

Conclusion: This case highlights a unique presentation of this rare clinical syndrome. Management of these patients can be difficult due to limited evidence of medications, and commonly requires a multidisciplinary approach with a focus on physical and occupational therapy to teach patients how to adapt to their new limitations.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/posterior-alien-hand-syndrome-an-unusual-variant-causing-ipsilateral-and-contralateral-synkinesis-a-case-report/