Transient alien hand syndrome, in a chronic depressive patient with recent Anterior Corpus Callosum Infarct

The term alien hand refers toa variety of clinical conditions characterized by theuncontrolled behavior or the feeling of strangeness of one extremity, most commonly the left hand. A common classification distinguishes it as the anterior motor form(1) and posterior sensory form. Symptoms following callosal lesions may or may not be accompanied by hemispheric damage, especially in the frontal medial region however Della Sala et al(15) Goldberg et al(14) have argued that, frontal lesion alone is sufficient to explain alien hand syndrome and callosal lesion need not be present.Case Report 59 year old female, a known case of depression with CVA, Hypertension and Diabetes mellitus presented with irrelevant talk, altered behavior, inability to recognize familiar faces objects and decreased self care. Examination revealed stable vitals, positive neurological findings were 7th nerve UMN palsy on left side with left sided hemiparesis, ill sustained attention, slurred speech, decline in constructional ability. Lobar function tests revealed dyscalculia, right- left disorientation, hemi neglect, finger agnosia, left limb apraxia and difficulty in bimanual coordination. Clinical diagnosis was CVA-multi infarct predominantly involving fronto parietal with left hemiparesis. Neuroimaging showed anterior corpus callosum infarct with gliosis in right parietal region confirmed the clinical features and Transient Alien hand syndrome. Neurologist concurred with same findings and patient showed improvement within few weeks of initiating treatment. Discussion and Conclusion In this patient the presence of limb apraxia and difficulty in bimanual coordinaton pointed towards the need for detailed work up and MRI revealed anterior corpus callosum infarct. Alien hand syndrome may be presenting with wide spectrum of motor and sensory deficits which may be caused by parietal, frontal or callosal lesions. This patient is a case of Transient Alien hand syndrome, probably due to motor involvement as a result of anterior corpus callosum infarct. Further research may be needed to conclude these findings