Objective: Alien hand syndrome (AHS) is a rare movement disorder that inspires fear to patients and confuses doctors. So we describe a rare case-report.

Background: Patient R., male, 46 y.o., was admitted to the clinic with complaints of weakness and impaired movement in the left hand, slowing down of the rate of speech and fuzziness. Describing the symptoms, the patient used the formulations “the hand does not obey”, “the hand has its own head.”

Method: Anamnesis morbi: the patient felt ill 5 weeks before the admission: on the stress background his left leg “failed”, speech became slurred. He was hospitalized to the neurological clinic, the diagnosis according to the documentation: Ischemic stroke in the right MCA basin. Dysarthria. Left-sided hemiparesis. Acute period. An urgently performed MRI of the brain revealed areas of cytotoxic edema in the frontal, parietal and occipital lobes and an extensive area of ​​paraventricular edema in the right hemisphere, as well as in the structure of the corpus callosum. On the 10th day of hospitalization due to the growing feeling of anxiety, he was discharged with positive dynamics against the background of ongoing therapy. At home the unmotivated feeling of anxiety worsened, the patient began to notice insomnia, so he turned back to the clinic.

Results: On neurological examination: Apraxia in the left hand: kinesthetic according to the visual and kinesthetic pattern, including transferring poses, kinetic, apraxia tests trying to perform only on the verbal model.
Clinical diagnosis: ischemic stroke in the right MCA circulation. Undifferentiated subtype. Light left-sided central upper monoparesis. Left-sided upper monohypalgesia. Left-sided AHS. Left-sided central prosoparesis, glossoparesis. Dysarthria. Early recovery period. Generalized clinical anxiety/depression disorder.
To control the “alien” hand the patient put on a cloth glove at home, held a cane in this hand or held his wife by the elbow outside. Also clonazepam 0.25 mg/day was added to the therapy. Due to anxiety/depression he was prescribed anti-anxiety medication and SSRIs. Completed a course of rehabilitation: mirror therapy, techniques for the development of fine motor skills and interhemispheric interaction, classes with a speech therapist.

Conclusion: After 2 months on rehabilitation the patient fully controls the function of the hand, and does not need to wear gloves. This is a case-report of really rare syndrome with a positive outcome.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/alien-hand-syndrome-in-ischemic-stroke-a-case-report/