Recently, there have been some reports regarding hyperkinetic motor behaviours contralateral to hemiplegia in acute stroke.1 2 These behaviours are probably the reflection of early plastic changes of brain maps and circuits after an acute lesion and an active process induced by disinhibition to establish new compensatory pathways.1 I encountered a peculiar case of a patient with right ipsilateral “hypersensation” after a right hemispheric infarction in the acute period who also presented severe left sensorimotor disturbance, hyperkinetic motor behaviours in the right upper limb, anosognosia for hemiplegia, and personal neglect. It was possible to record the patient's subjective experience of the acute phase, which was helpful for understanding the mechanism of anosognosia.

A 76 year old right handed woman was admitted to hospital soon after the onset of left hemiparesis and hemisensory disturbance. She had undergone implantation of a cardiac pacemaker because of sick sinus syndrome. On neurological examination, she was awake and oriented to time and place, but showed inattention and motor impersistence. There was no aphasia or apraxia, but mild left hemispatial neglect was detected. Left hemiparesis was noticed (upper limb 0/5; lower limb 2/5, and face 3/5). Sensory loss was complete in all modalities in the upper limb and severe in the face and lower limb, being slightly preserved for pain and coldness. She denied the existence of left hemiparesis and had completely lost the sensation of ownership of her left hemibody. When I asked her the owner of …