Alien hand syndrome is a rare neurological phenomenon that has been noted to arise in the setting of stroke, vascular malformations, tumors, and trauma. Here we report this phenomenon which occurred as a presenting symptom in a patient with acute ischemic stroke.

54-year-old male presented to the hospital with acute onset involuntary movements along with numbness of the left arm. The patient stated that he suddenly felt his left arm involuntarily hitting his left thigh and these movements recurred multiple times. The patient had no control over the movements of his left arm during this period. Upon presentation to the emergency department, CT-angiographic imaging of the head and neck was conducted. It revealed occlusion of the M3/M4 segment of the posterior division of the right middle cerebral artery with associated ischemia. The patient was given intravenous thrombolytic therapy for acute stroke treatment, and his symptoms resolved soon thereafter. Subsequent MRI imaging revealed small infarcts in the right insular cortex. The patient was discharged with complete resolution of symptoms. Anti-platelet and statin therapy were added to the patient’s medication regimen on discharge for secondary prevention.

This case exhibits transient alien hand syndrome which presented as a unique symptom of acute ischemic stroke. Given its rarity, clinicians should be cognizant of this phenomenon in order to adequately manage emergent conditions associated with this unique disorder.