Abstract Details

Title Stroke-induced Co-occurrence of Supernumerary Phantom Limbs, Fregoli Syndrome, and Reduplicative Paramnesia

Topic Aging, Dementia, and Behavioral Neurology

Presentation(s) P8 - Poster Session 8 (11:45 AM-12:45 PM)

Poster/Presentation
Number 13-007

Objective To describe the co-occurence of misidentification syndromes after stroke.

Background Supernumerary phantom limb usually involves the anterior sensory motor area of the non-dominant parietal lobe (Srivatsava, 2008). Reduplicative paramnesia has been localised to the frontal lobe, disconnecting temporal limbic structures and Fregoli's syndrome to the non-dominant parietal and frontal lobes (Maria Teixeira-Dias, 2022; Weinstein, 1954; Politis, 2012; Feinberg, 2005). The co-occurrence of these has not heretofore been described.

Design/Methods This 60-year-old right-handed male noticed sudden onset of left-sided weakness followed by perception of four left arms and two left legs. Resembling a marionettist, when he moved his arms and legs, all the hallucinated arms and legs would also move synchronously. When grabbing the chimeric arms with his right hand, they would disappear for minutes to hours. At the same time, he believed that strangers were all the same stranger, who was familiar to him. Moreover, he perceived the hospital was also replicated like a photocopy. After two months, all three delusions resolved.

Results

Mental status: Attention: neglect the left side of the room. Ideomotor apraxia of the left upper extremity. Clock drawing: neglect of the left. Cranial Nerve (CN): CN V: absent light touch and pinprick on the left. CN VII: decreased left-sided smile. Motor: Facilitory paratonia of the left upper extremity. Strength: 4/5 left upper extremity. Left downward drift. Gait: unable to walk. Cerebellar: left finger-to-nose dysmetria. Sensory: extinction to double simultaneous stimulation on the left. Decreased light touch, pinprick, and proprioception on the left. Reflexes: 3+ throughout the left. Left Babinski. Magnetic Resonance Imaging: Infarction within the right thalamus and inframedial margin of the right temporal lobe.

Conclusions Supernumerary limbs have been observed with lesions adjacent to the areas where Fregoli and reduplicative paramnesia occur (Srivastava, 2008; Kakegawa, 2020; Diamantaras, 2023). Through neighbourhood effect, all these regions could have been damaged.

Authors/Disclosures
Porschia Brown, Medical Student PRESENTER	Ms. Brown has nothing to disclose.
Nethra Somannagari, MBBS	Dr. Somannagari has nothing to disclose.
Alan R. Hirsch, MD, FACP (Illinois Center for Neurologial and Behavioral Medicine, Ltd.)	Dr. Hirsch has nothing to disclose.

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