异形手综合征(AHS)是戈德斯坦一个多世纪前首次描述的一种罕见的神经系统现象。文献中最广泛认可的变体是正面的,call骨,和后部AHS。由于call体病变引起的AHS可以单独发生或作为call体断开综合征(CDS)的一部分发生。本报告提供了一个独特的CDS病例,显示了所有三种AHS变体的临床特征,由广泛的call体梗死引起。我们的患者表现出来自三种AHS变体的各种临床特征,其中包括抓取,摸索,并且难以从手(前部)释放物体;手间冲突(call骨);手臂悬浮,轻度偏瘫,和半叶感觉丧失(后部)。此外,广泛破坏的call体纤维产生了CDS的神经系统表现,如认知障碍,意识运动和结构性失用症,行为障碍,以及经皮质运动性失语.我们采用了一系列的康复干预措施,如镜盒疗法,肢体约束策略,口头提示训练,认知行为疗法,双手训练,言语和语言治疗,和氯硝西泮的药物治疗。患者在卒中后9个月显示CDS和AHS特征几乎完全消退。我们的病例报告强调了AHS的独特临床变化以及临床表现与神经解剖学基础之间的挑战性相关性。未来的研究有必要探索复杂的神经连接和call体的精确功能。这可以通过将全面的神经心理学测试与扩散张量纤维束成像研究相结合来实现。开发经过验证的工具以标准化AHS评估也至关重要。最后,在康复干预中缺乏证据,因此有必要开展进一步研究,以解决AHS和CDS管理方面的广泛知识差距.
Alien hand syndrome (AHS) is a rare neurological phenomenon first described by Van Vleuten over a century ago. The most widely recognized variants in literature are frontal, callosal, and posterior AHS. AHS due to the corpus callosum lesion can occur alone or as part of callosal disconnection syndrome (CDS). This report presents a unique CDS
case manifesting clinical features from all three AHS variants, resulting from an extensive corpus callosum infarct. Our patient exhibited various clinical features from the three AHS variants, which include grasping, groping, and difficulty releasing objects from the hand (anterior); intermanual conflict (callosal); arm levitation, mild hemiparesis, and hemisensory loss (posterior). Additionally, the extensive disruption of the corpus callosal fibers produced neurological manifestations of CDS, such as cognitive impairment, ideomotor and constructional apraxia, behavioral disorder, and transcortical motor aphasia. We employed a range of rehabilitation interventions, such as mirror box therapy, limb restraint strategy, verbal cue training, cognitive behavioral therapy, bimanual hand training, speech and language therapy, and pharmacological treatment with clonazepam. The patient showed almost complete resolution of CDS and AHS features by nine months post-stroke Our
case report highlights distinctive clinical variations of AHS and the challenging correlation between clinical manifestations and neuroanatomical substrates. Future studies are necessary to explore the intricate neural connections and the precise function of the corpus callosum. This can be achieved by combining comprehensive neuropsychological testing with diffusion tensor tractography studies. It is also essential to develop a validated tool to standardize AHS assessment. Finally, the scarcity of evidence in rehabilitation interventions necessitates further studies to address the wide knowledge gap in AHS and CDS management.