Ego-syntonic alien hand syndrome after right posterior cerebral artery stroke

The alien hand syndrome classically consists of involuntary movements accom panied by a feeling of foreignness and personification of the affected limb . Autocriticism, in which patients criticize and express astonished frustra tion with the behavior of the autonomous limb, is a commonly noted feature. Most cases of alien hand are associated with lesions of the supplementary motor areas of the frontal lobes, the corpus callosum, or both. The authors report on a 79-year-old man who sustained a right posterior cerebral arter y distribution infarction and developed alien hand syndrome in the absence of callosal involvement. Also unique is that the patient perceived the alie n hand as acceptable and positive, not hostile and repugnant. This case sug gests not only that the neuroanatomic regions responsible for alien hand sy ndrome may require re-examination, but also that its definition may need ex pansion. (C) 1999 by the American Congress of Rehabilitation Medicine and t he American Academy of Physical Medicine and Rehabilitation.