Posterior alien hand syndrome in a patient with parieto-occipital infarction: a presentation mimicking anterior variant features - a case report

Sep 29, 2026

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Alien hand syndrome is a rare neurological condition marked by involuntary limb movements that the patient experiences as foreign, classically linked to anterior or posterior brain lesions. This case report describes a unique posterior alien hand syndrome overlapping with anterior-form features. A 76-year-old man developed acute confusion with uncontrollable right arm movements after a fall; imaging evolved to show a left posterior circulation infarct. Treatment included aspirin, temporary edoxaban cessation, quetiapine for agitation, then reinstitution of edoxaban once stability was confirmed.

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Abstract

Background

Case presentation

Management and outcome

Conclusion

Introduction

Elhaj et al. Journal of Medical Case Reports (2026) 20:8 [https://doi.org/10.1186/s13256-025-05718-w](https://doi.org/10.1186/s13256-025-05718-w) Journal of Medical Case Reports CASE REPORT Open Access Posterior alien hand syndrome in a patient with parieto-occipital infarction: a presentation mimicking anterior variant features—a case report Ammar Elhaj1, Hadeel A. S Abdalla 1* , Islam Elhassan 1, Mohammed Elhassan 1 and Saga Mohamed 1 Abstract Background Alien hand syndrome is a rare condition characterized by involuntary movements of a limb that the patient perceives as alien and is usually associated with anterior or posterior brain lesions. This case involved a unique posterior alien hand syndrome overlapping with the anterior form. Case presentation A 76-year-old Caucasian male patient presented to the emergency department with acute confusional state associated with involuntary movement of the right arm subsequent to a fall. His medical his tory included recurrent pulmonary embolism treated with edoxaban, diabetes, and hypertension. Initial computed tomography imaging indicated chronic changes; nevertheless, within 24 h, his symptoms intensified, and subsequent imaging demonstrated a left posterior circulation infarct. His uncontrollable arm movements resulted in a diagnosis of posterior alien hand syndrome. Management and outcome Management involved the use of aspirin, temporary cessation of edoxaban, and agitation management with quetiapine. After confirming the stability of the infarction, edoxaban was reintroduced. This case underscores the difficulties in treating alien hand syndrome and anticoagulation in a complicated stroke scenario. Conclusion This case underscores the varied manifestations of alien hand syndrome variations, indicating a complicated interaction among anatomical regions. A multidisciplinary approach is crucial for the management of alien hand syndrome, especially in instances with overlapping features. Keywords Alien hand syndrome (AHS), Posterior circulation infarct (PCA), Involuntary movements, Stroke management, Neurological complications Introduction Alien hand syndrome (AHS) is a rare and complex neurological disorder characterized by involuntary movements of a limb, typically the hand, which the patient perceives as being foreign or not under their control. The *Correspondence: Hadeel A. S Abdalla [ali.ad.hadeel@gmail.com](ali.ad.hadeel@gmail.com) 1 University Hospital Waterford, Waterford, Ireland term “main étrangère” or “alien hand” was introduced by Brion and Jedynak in 1972, highlighting the disconnection between the limb’s movements and the individual’s conscious intention [1, 2]. The syndrome can arise after diverse neurological insults, such as stroke, traumatic brain injury, or neurodegenerative diseases, indicating its multifactorial nature [3, 4]. The clinical manifestations of AHS encompass a feeling of disconnection from the diseased limb, which may presumably execute intentional movements © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To vi

FAQs

What is alien hand syndrome and what makes this case notable?

Alien hand syndrome involves involuntary limb movements perceived as alien by the patient. This report is notable for posterior alien hand syndrome overlapping with anterior-variant features.

How did the patient present and what did imaging show?

A 76-year-old man presented with acute confusion and involuntary right arm movements after a fall. Symptoms intensified within 24 hours, and subsequent imaging demonstrated a left posterior circulation infarct.

What treatments were used and how did management proceed?

Management included aspirin, temporary cessation of edoxaban, and agitation control with quetiapine. After confirming infarct stability, edoxaban was reintroduced.

Sep 29, 2026

Uploaded by Kurz