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Medial Frontal Cortex Infarction and the Alien Hand Sign

Medial Frontal Cortex Infarction and the Alien Hand Sign Abstract • Two right-handed patients with infarction involving the left medial frontal cortex are described. Both patients exhibited a form of transcortical motor aphasia and a psychomotor disturbance involving the right arm characterized by forced grasping, motor perseveration, and the presence of apparently purposeful movements that appeared to be dissociated from conscious volition. The latter feature is noted to be identical to the alien hand sign as described in the left arm of commissurotomized patients and patients with callosal neoplasm or infarction. It is suggested that the observed dissociation of conscious intention from purposeful movement may be related to dysfunction of the medial frontal cortex contralateral to the impaired extremity as much as to hemispheric disconnection. References 1. Brion S, Jedynak C-P: Trouble du transfert interhémisphérique à propos de trois observations de tumeurs du corps calleux: Le signe de la main étrangére . Rev Neurol 1972;126:257-266. 2. Bogen JE: The callosal syndrome , in Heilman KM, Valenstein E (eds): Clinical Neuropsychology . New York, Oxford University Press, 1979, pp 308-359. 3. Geschwind N: Disconnexion syndromes in animals and man . Brain 1965;88:237-294, 585-644.Crossref 4. Goldstein K, cited by Geschwind N: Disconnexion syndromes in animals and man . Brain 1965;88:237-294, 585-644.Crossref 5. Wilson DH, Reeves A, Gazzaniga M, et al: Cerebral commissurotomy for control of intractable seizures . Neurology 1977;27:708-715.Crossref 6. Damasio AR, Van Hoesen GW: Structure and function of the supplementary motor area . Neurology 1980;30:359. 7. Goldstein K: Language and Language Disturbances . New York, Grune & Stratton Inc, 1948. 8. Masdeu JC, Schoene WC, Funkenstein H: Aphasia following infarction of the left supplementary motor area . Neurology 1978;28:1220-1223.Crossref 9. Alexander MP, Schmitt MA: The aphasia syndrome of stroke in the left anterior cerebral artery territory . Arch Neurol 1980;37:97-100.Crossref 10. Rubens AB: Aphasia with infarction in the territory of the anterior cerebral artery . Cortex 1975;11:239-250.Crossref 11. Környey E: Aphasie transcorticale et écholalie: Le probléme de l'initiative de la parôle . Rev Neurol 1975;131:347-363. 12. Brown J: Mind, Brain and Consciousness: The Neuropsychology of Cognition . New York, Academic Press Inc, 1977. 13. Shahani B, Burrows P, Whitty CWM: The grasp reflex and perseveration . Brain 1970;93:181-192.Crossref 14. Wilson DH, Reeves A, Gazzaniga M: Division of the corpus callosum for uncontrollable epilepsy . Neurology 1978;28:649-653.Crossref 15. Penfield W, Jasper H: Epilepsy and the Functional Anatomy of the Human Brain . Boston, Little Brown & Co, 1954, pp 88-108. 16. Talairach J, Bancaud J, Geier S, et al: The cingulate gyrus and human behavior . Electroencephalogr Clin Neurophysiol 1973;34:45-52.Crossref 17. Sanides F: Functional architecture of motor and sensory cortices in primates in the light of a new concept of neocortex evolution , in Noback C, Montagna W (eds): The Primate Brain . New York, Appleton-Century-Crofts, 1970, pp 137-208. 18. Mountcastle VB, Lynch JC, Georgopoulos A, et al: Posterior parietal association cortex of the monkey: Command functions for operations within extrapersonal space . J Neurophysiol 1975;38:871-908. 19. Robinson DL, Goldberg ME, Stanton GB: Parietal association cortex in the primate: Sensory mechanisms and behavioral modulations . J Neurophysiol 1978;41:910-932. 20. Mesulam M-M, Van Hoesen GW, Pandya DN, et al: Limbic and sensory connections of the inferior parietal lobule (area PG) in the rhesus monkey: A study with a new method for horseradish peroxidase histochemistry . Brain Res 1977;136:393-414.Crossref 21. Baleydier C, Mauguiere F: The duality of the cingulate gyrus in the monkey: Neuroanatomical study and functional hypothesis . Brain 1980;103:525-554.Crossref 22. Roland PE, Larsen B, Lassen NA, et al: Supplementary motor area and other cortical areas in organization of voluntary movements in man . J Neurophysiol 1980;43:118-136. 23. Roland PE, Skinhøj E, Lassen NA, et al: Different cortical areas in man in organization of voluntary movements in extrapersonal space . J Neurophysiol 1980;43:137-150. 24. Larsen B, Skinhøj E, Lassen NA: Variations in regional cortical blood flow in the right and left hemispheres during automatic speech . Brain 1978;101:193-209.Crossref 25. Orgogozo JM, Larsen B: Activation of the supplementary motor area during voluntary movement in man suggests it works as a supramotor area . Science 1979;206:847-850.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Medial Frontal Cortex Infarction and the Alien Hand Sign

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Publisher
American Medical Association
Copyright
Copyright © 1981 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1981.00510110043004
Publisher site
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Abstract

Abstract • Two right-handed patients with infarction involving the left medial frontal cortex are described. Both patients exhibited a form of transcortical motor aphasia and a psychomotor disturbance involving the right arm characterized by forced grasping, motor perseveration, and the presence of apparently purposeful movements that appeared to be dissociated from conscious volition. The latter feature is noted to be identical to the alien hand sign as described in the left arm of commissurotomized patients and patients with callosal neoplasm or infarction. It is suggested that the observed dissociation of conscious intention from purposeful movement may be related to dysfunction of the medial frontal cortex contralateral to the impaired extremity as much as to hemispheric disconnection. References 1. Brion S, Jedynak C-P: Trouble du transfert interhémisphérique à propos de trois observations de tumeurs du corps calleux: Le signe de la main étrangére . Rev Neurol 1972;126:257-266. 2. Bogen JE: The callosal syndrome , in Heilman KM, Valenstein E (eds): Clinical Neuropsychology . New York, Oxford University Press, 1979, pp 308-359. 3. Geschwind N: Disconnexion syndromes in animals and man . Brain 1965;88:237-294, 585-644.Crossref 4. Goldstein K, cited by Geschwind N: Disconnexion syndromes in animals and man . Brain 1965;88:237-294, 585-644.Crossref 5. Wilson DH, Reeves A, Gazzaniga M, et al: Cerebral commissurotomy for control of intractable seizures . Neurology 1977;27:708-715.Crossref 6. Damasio AR, Van Hoesen GW: Structure and function of the supplementary motor area . Neurology 1980;30:359. 7. Goldstein K: Language and Language Disturbances . New York, Grune & Stratton Inc, 1948. 8. Masdeu JC, Schoene WC, Funkenstein H: Aphasia following infarction of the left supplementary motor area . Neurology 1978;28:1220-1223.Crossref 9. Alexander MP, Schmitt MA: The aphasia syndrome of stroke in the left anterior cerebral artery territory . Arch Neurol 1980;37:97-100.Crossref 10. Rubens AB: Aphasia with infarction in the territory of the anterior cerebral artery . Cortex 1975;11:239-250.Crossref 11. Környey E: Aphasie transcorticale et écholalie: Le probléme de l'initiative de la parôle . Rev Neurol 1975;131:347-363. 12. Brown J: Mind, Brain and Consciousness: The Neuropsychology of Cognition . New York, Academic Press Inc, 1977. 13. Shahani B, Burrows P, Whitty CWM: The grasp reflex and perseveration . Brain 1970;93:181-192.Crossref 14. Wilson DH, Reeves A, Gazzaniga M: Division of the corpus callosum for uncontrollable epilepsy . Neurology 1978;28:649-653.Crossref 15. Penfield W, Jasper H: Epilepsy and the Functional Anatomy of the Human Brain . Boston, Little Brown & Co, 1954, pp 88-108. 16. Talairach J, Bancaud J, Geier S, et al: The cingulate gyrus and human behavior . Electroencephalogr Clin Neurophysiol 1973;34:45-52.Crossref 17. Sanides F: Functional architecture of motor and sensory cortices in primates in the light of a new concept of neocortex evolution , in Noback C, Montagna W (eds): The Primate Brain . New York, Appleton-Century-Crofts, 1970, pp 137-208. 18. Mountcastle VB, Lynch JC, Georgopoulos A, et al: Posterior parietal association cortex of the monkey: Command functions for operations within extrapersonal space . J Neurophysiol 1975;38:871-908. 19. Robinson DL, Goldberg ME, Stanton GB: Parietal association cortex in the primate: Sensory mechanisms and behavioral modulations . J Neurophysiol 1978;41:910-932. 20. Mesulam M-M, Van Hoesen GW, Pandya DN, et al: Limbic and sensory connections of the inferior parietal lobule (area PG) in the rhesus monkey: A study with a new method for horseradish peroxidase histochemistry . Brain Res 1977;136:393-414.Crossref 21. Baleydier C, Mauguiere F: The duality of the cingulate gyrus in the monkey: Neuroanatomical study and functional hypothesis . Brain 1980;103:525-554.Crossref 22. Roland PE, Larsen B, Lassen NA, et al: Supplementary motor area and other cortical areas in organization of voluntary movements in man . J Neurophysiol 1980;43:118-136. 23. Roland PE, Skinhøj E, Lassen NA, et al: Different cortical areas in man in organization of voluntary movements in extrapersonal space . J Neurophysiol 1980;43:137-150. 24. Larsen B, Skinhøj E, Lassen NA: Variations in regional cortical blood flow in the right and left hemispheres during automatic speech . Brain 1978;101:193-209.Crossref 25. Orgogozo JM, Larsen B: Activation of the supplementary motor area during voluntary movement in man suggests it works as a supramotor area . Science 1979;206:847-850.Crossref

Journal

Archives of NeurologyAmerican Medical Association

Published: Nov 1, 1981

References