Feinberg et al have recently reported the association between anosognosia for hemiplegia and the illusion of movement of the paralysed upper limb.1 They considered the illusion a form of confabulation that is distinct from other phantom phenomena. This explanation is not supported by my findings in a patient with a stroke who experienced transient purposeful movements of his paretic hand.

The patient was a 66 year old right handed man who presented with acute onset weakness of his right arm and leg and slurring of his speech. He was known to be hypertensive and a non-insulin dependent diabetic patient. Neurological examination confirmed the presence of right hemiplegia with facial involvement and mild to moderately severe dysphasia. Muscle power, as measured by the Medical Research Council (MRC) scale, was 1/5 and 2/5 in the upper and lower limbs respectively. Spinothalamic and posterior column sensations were intact. No visual field defects were found on examination using the confrontation method. There was no astereognosis or sensory extinction of tactile or visual stimuli. The patient was alert and cooperative. His comprehension of spoken and written language was good …

Dr Todd E Feinberg

Dr Todd E Feinberg