Left alien hand sign and mirror writing after left anterior cerebral artery infarction

doi:10.1016/0090-3019(91)90007-V

Surgical Neurology

Volume 35, Issue 4, April 1991, Pages 290-293

https://doi.org/10.1016/0090-3019(91)90007-V Get rights and content

Abstract

A 43-year-old, right-handed man was admitted complaining of peculiar movements of his left hand. Computed tomography scan and magnetic resonance imaging showed an infarct area in the territory of the left anterior cerebral artery. The abnormal movements of the left hand were diagnosed as so-called alien hand sign. This patient also exhibited mirror writing with his left hand. The clinical manifestations and neuroradiological findings of this case are described in detail, and the possible mechanisms of these extremely rare combinations of alien hand sign and mirror writing are discussed.

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Cited by (17)

Persistent left unilateral mirror writing: A neuropsychological case study
2010, Brain and Language
Mirror writing (MW) is a rare disorder in which a script runs in direction opposite to normal and individual letters are reversed. The disorder generally occurs after left-hemisphere lesions, is transient and is observed on the left hand, whereas usually motor impairments prevent assessment of direction of right handwriting. We describe a left-handed patient with complete left hand mirror writing, still evident 2 years after a hemorrhagic stroke in left nucleo-capsular region. Since the patient could write with his right hand he underwent several writing tasks with either hand, and a thorough assessment to clarify the nature of MW. MW was evident in writing to dictation with left hand only, both in right and left hemispace, but the patient could modify his behavior when a verbal instruction was provided. No mirror errors were found in reading words, in copying geometric figures and in spatial orientation tasks. MW in our patient could be accounted for by a failure in automatic transformation of grapho-motor programs to write with the left hand. A lack of concern (a sort of anosodiaphoria) and a poor cognitive flexibility could contribute to long-term persistence of MW.
Alien hand syndrome due to a corpus callosum infarct: A case report
2004, Revue Neurologique
Un homme de 64 ans a présenté le syndrome de la main gauche étrangère ressentie comme extériorisée et ne lui appartenant plus, associé à des manifestations traduisant un conflit inter-manuel, sans signe en faveur d’une apraxie frontale ou pariétale. Ce syndrome était secondaire à un infarctus limité à la partie postérieure droite du splenium du corps calleux par embolie d’origine cardiaque. Le syndrome de la main étrangère est rare dans la pathologie cérébro-vasculaire. Cette observation vient enrichir le tableau émergeant des syndromes de la main étrangère de type calleux, secondaire à un infarctus calleux postérieur.
A 64-year-old man with alien hand syndrome presented with abnormal feelings in the left upper limb, associated with an intermanual conflict. There were no clinical signs of frontal or parietal apraxia. This syndrome was induced by an infarct localized in the right posterior area of the splenium, subsequent to a cardiogenic embolus. This observation enlightens the rising syndrome of callosal type alien syndrome due to a posterior callosal infarct.
Hemispatial factors in mirror writing
1993, Neuropsychologia
The effect of the hemispace in which writing was performed was assessed in two left hemisphere stroke patients who demonstrated left-handed mirror writing. Both patients produced significantly more mirrored words when writing in right, as compared to left (body) hemispace. We suggest that writing in the right hemispace activates the left hemisphere. Further, we propose that mirror writing in the right hemispace is attributable to activation of the damaged left hemisphere spatial system, which fails to assist in the translation of right hand motor programs into those appropriate to the left hand. Writing in left hemispace, in contrast, activates the intact right hemisphere based spatial system which guides the execution or monitoring of motor productions in left hemispace. The result is writing which remains directionally correct when the left hand is used in left hemispace.
Left hand mirror writing with right alien hand syndrome in a patient following an infarct near the right genu of the corpus callosum
2017, Neurology Asia
Supplementary motor complex and disturbed motor control - A retrospective clinical and lesion analysis of patients after anterior cerebral artery stroke
2015, Frontiers in Neurology
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2014, Tremor and Other Hyperkinetic Movements

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Left alien hand sign and mirror writing after left anterior cerebral artery infarction

Abstract

J Neurolinguistics

Cortex

Studies on the corpus callosum, IV. Diagonistic dyspraxia in epileptics following partial and complete section of the corpus callosum

Am J Psychiatry

The alien hand syndrome

Die Spiegelschrift der linken Hand

The callosal syndrome

Trouble du transfert interhemispherique a propos de trois observations de tumeurs du corps calleux: Le signe de la main etrangere

Rev Neurol

Mirror movements in hemiparesis

Confin Neurol

Anterior cerebral artery and its syndromes

Brain

The significance of mirror writing

Occurrence and mechanisms of occlusion of the anterior cerebral artery

Stroke