Abstract 007: When Autonomy Goes Astray: An Unsettling Window into curious case of Alien Limb Phenomenon

Introduction We present a unique case of the callosal variant of alien limb phenomenon, manifesting as an “alien foot” in the setting of a splenial corpus callosum infarction. Case Presentation 55‐year‐old female with past medical history of HTN, TIA , HLD, DM initially presented to ED with several days of right‐sided headache associated with right face paresthesias, intermittent right hemifacial spasms involving right face, eyes, lower jaw, lasting about 1‐2 minutes. Initial CTH negative for any infective workup: VDRL, viral etiology, gram staining, west nile, toxoplasmosis, borrelia, VZV; ACE level, IgG index and Meningitis film array. Patient underwent angioplasty for R A1 Stenosis and was eventually discharged home after clinical stabilization and prolonged monitoring. Patient presented after three months to ED with chief complaint of weird feeling in right part of her brain in which her right upper and lower extremity were not following her will or voluntary commands of going to the restroom by turning to right and even after thinking about it, she felt that her right leg and hand were not acting synergistically to follow her wishes. Discussion Alien limb phenomenon typically arises later in the course of stroke recovery and is most commonly associated with anterior or posterior cerebral artery infarcts. It involves the perception of a limb as foreign, accompanied by involuntary motor activity, and may be associated with apraxia, intermanual conflict, or self‐restriction. Callosal AHS results from anterior corpus callosum lesions and leads to hemispheric disconnection, especially during tasks requiring dominant hemisphere control. In this patient, the infarct involved the right paramedian frontal lobe and splenium, within the ACA territory. Her symptoms of intermanual conflict and apraxia are consistent with the callosal variant of AHS. Conclusion Further characterization of involuntary movements in brain‐injured patients may offer valuable insights into motor control, awareness, and reorganization following cerebral injury. image