Alien Limb Phenomenon and Cerebral Injury Following Splenial Infarction

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 & CTP were unremarkable. CTA revealed stenosis of R A1, R P2, & L P2 segments. MRI demonstrated signal changes in splenium bilaterally. She continued to report intermittent headaches even with verapamil and thus stat CTH was performed revealing new hypodensities in right corpus callosum. Repeat MRI brain showed acute infarct in right paramedian frontal lobe and splenium of corpus callosum. Patient underwent IR guided to rule out vasculitis. DSA demonstrated right proximal A1 severe & b/l PCA Stenosis. CSF Results WBC 0, RBC 18, PRO 49, GLU 88; 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.