Article
Alien hand syndrome in ruptured aneurysms – a systematic review and case report
Alien Hand Syndrom bei rupturierten Aneurysmen – eine systematische Übersichtsarbeit und Case Report
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Authors
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Anna Cecilia Lawson McLean
- Helios Klinikum Erfurt, Klinik für Neurochirurgie, Erfurt, Deutschland
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Elmar Lobsien
- Helios Klinikum Erfurt, Erfurt, Deutschland; Helios Klinikum Erfurt, Klinik für Neurologie, Erfurt, Deutschland
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Elke Leinisch
- Helios Klinikum Erfurt, Klinik für Neurologie, Erfurt, Deutschland
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Rüdiger Gerlach
- Helios Klinikum Erfurt, Klinik für Neurochirurgie, Erfurt, Deutschland
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Donald Lobsien
- Helios Klinikum Erfurt, Institut für Neuroradiologie, Erfurt, Deutschland
| Published: | June 4, 2021 |
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Outline
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Objective: Alien hand syndrome (AHS) is a rare condition which is typically associated with lesions of the corpus callosum (CC) and of the supplementary motor area (SMA). Subarachnoid haemorrhage (SAH) due to cerebral aneurysm have been reported to be a potential cause for this condition. The pathogenesis and prognosis have been subject to controversies. In order to shed light on this rare condition we performed a systematic review and add a novel case to the literature.
Methods: We performed a literature search on PubMed and Medline using the search terms (“alien hand” OR “anarchic hand” OR “disconnection syndrome”) AND “aneurysm”. After screening all abstracts for inclusion, we identified additional papers for inclusion by hand-searching all references. We extracted all data on clinical presentation, treatment, radiological findings and follow-up. Furthermore, we added our own findings in a previously unpublished case.
Results: 17 cases were eligible for inclusion, including the novel case from our centre. Aneurysms of the anterior communicating artery (ACoA) (10/17) were the most common origin of SAH that led to AHS, followed by pericallosal artery (PA) aneurysms (7/10). A majority of aneurysms underwent clipping (13/17), whereas 2/17 underwent coiling, and 2/17 were not treated interventionally. CC lesions were seen in all cases with computed tomography imaging (n=16), supplementary SMA lesions were described in 10/16 cases. 14/17 patients exhibited intermanual conflict and in 13/17 cases additional disconnection symptoms were described. The median follow-up was 4 months (range 0 – 72 months) and in 8/9 cases where follow-up findings were reported, the AHS symptoms improved.
Conclusion: Lesions of the CC and SMA caused by ruptures of ACoA or PA aneurysms may result in AHS. During treatment of these types of aneurysms damage to the mesial frontal cortex should be avoided in order to keep symptoms minimal. Mid-term follow-up indicates that commonly there is a favourable prognosis and regression of symptoms.
