Abstract Details

Title Her & Him: The Curious Case of the Discourteous Limb

Topic Aging, Dementia, and Behavioral Neurology

Presentation(s) Behavioral and Cognitive Neurology Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 046

Objective To report the behavioral and motor phenomena in a case of stroke-induced, right-handed alien limb

Background The majority of alien limbs involve the left hand and are associated with right hemispheric dysfunction, a pattern known to disrupt bodily self-consciousness.

Design/Methods 75yo female with acute ischemic stroke is interviewed, examined, and an MRI is obtained.

Results The patient expresses both anarchic limb phenomena, whereby an individual’s complex limb movements are unintended and occur outside of volitional control, and alien limb phenomena, whereby complex limb actions lack the experience of self-ownership. Remarkably, she self-describes the limb as more than merely lacking her own agency but instead as being controlled by a different agent with human-like qualities. This non-self, limb-controlling agent is male gendered and possesses emotional states (“It seems he is agitated, too”) and a rudimentary theory of mind (“He knows I’m talking about him”). The male gender is ascribed as a contrast to her identity as a woman (“If it was a she, she’d be a part of me”) and, possibly, through its aggressive tendencies (“I can’t stand him coming at me … he makes me look like a jerk … I hate him”). MRI Brain disclosed an area of restricted diffusion representing acute ischemic infarction extending along the cortex of the left post-central gyrus as well as involving the cortex and subcortical white matter of the left pre-central and cingulate gyri and the left inferior parietal lobe down to the posterior insula. Her symptoms resolved in several weeks (“He has come back to me”).

Conclusions Potentially this misplaced agency (vs absent agency) is due to her primary left hemisphere involvement, where although right hemispheric core self-representational regions are spared, their inputs from left hemisphere structures are injured, leading to dysfunctional-but-not-absent representations of the body onto an agential being: “Him.”

Authors/Disclosures
Michael P. Stanley, MD (Tufts Medical Center) PRESENTER	Dr. Stanley has received personal compensation in the range of $0-$499 for serving as a Consultant for Roon. Dr. Stanley has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Annals of Neurology. Dr. Stanley has stock in Roon. Dr. Stanley has received personal compensation in the range of $0-$499 for serving as a writer at large with WBUR/Cognoscenti . Dr. Stanley has received personal compensation in the range of $0-$499 for serving as a Poet with Writing the Land. Dr. Stanley has received personal compensation in the range of $0-$499 for serving as a writer at large with Psyche. Dr. Stanley has received personal compensation in the range of $0-$499 for serving as a Writer at large with Wall Street Journal.
Meabh O'Hare, MD (Brigham & Women's Hospital)	Dr. O'Hare has nothing to disclose.
Joshua P. Klein, MD, PhD, FANA, FAAN (Brigham and Women's Hospital)	Dr. Klein has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for SAGE Publishers. Dr. Klein has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for McGraw-Hill Publishers. Dr. Klein has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Oakstone Publishers. Dr. Klein has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wolters Kluwer Publishers. Dr. Klein has received personal compensation in the range of $100,000-$499,999 for serving as an Expert Witness for various law firms. Dr. Klein has received publishing royalties from a publication relating to health care.
Michael G. Erkkinen, MD (Brigham and Women's Hospital)	Dr. Erkkinen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen.

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