STROKE-RELATED ALIEN HAND SYNDROME: ETIOLOGY,CLINICAL PRESENTATION AND MANAGEMENT A SYSTEMATIC REVIEW

Gabriela Gilarska; Julianna Cholewa; Radosław Januszczak; Maja Sygacz; Agnieszka Barbara  Białek; Wiktoria Bojarska

doi:10.31435/ijitss.2(50).2026.5627

Authors

Gabriela Gilarska Medical University of Lublin, Faculty of Medicine, 19 Chodźki St, 20-093 Lublin, Poland https://orcid.org/0009-0004-4818-8070
Julianna Cholewa Medical University of Lublin, Faculty of Medicine, 19 Chodźki St, 20-093 Lublin, Poland https://orcid.org/0009-0007-2432-1828
Radosław Januszczak University Clinical Hospital No. 4 in Lublin, ul. Doktora Kazimierza Jaczewskiego 8, 20-090 Lublin, Poland https://orcid.org/0009-0007-4088-8138
Maja Sygacz University Clinical Hospital No. 4 in Lublin, ul. Doktora Kazimierza Jaczewskiego 8, 20-090 Lublin, Poland https://orcid.org/0009-0006-8689-8975
Agnieszka Barbara Białek Medical University of Lublin, Faculty of Medicine, ul. Witolda Chodźki 19, 20-093 Lublin, Poland https://orcid.org/0009-0004-0855-7732
Wiktoria Bojarska University Clinical Hospital No. 4 in Lublin, ul. Doktora Kazimierza Jaczewskiego 8, 20-090 Lublin, Poland https://orcid.org/0009-0008-6923-2068

DOI:

https://doi.org/10.31435/ijitss.2(50).2026.5627

Keywords:

Alien Hand Syndrome, Anarchic Hand, Stroke, Corpus Callosum, Anterior Cerebral Artery, Supplementary Motor Area, Rehabilitation

Abstract

Background: Alien hand syndrome (AHS) is a relatively rare neurological disorder characterized by involuntary, purposeful movements of a limb, as well as a sense of foreignness toward the affected limb. Recently, an increasing number of cases of alien hand syndrome has been observed; despite this, the pathophysiology, classification, and diagnostic management remain significant challenges for modern medicine. Stroke represents one of the earliest identified and potentially reversible causes.

Objective: To systematically review the etiology, clinical presentation, neuroanatomical substrates, and management of stroke-related AHS.

Methods: PubMed, Embase, Scopus, and Web of Science databases were searched from inception to 2025 using terms including "alien hand syndrome," "anarchic hand," and "stroke." Studies reporting AHS following ischemic or hemorrhagic stroke with neuroimaging confirmation were included.

Results: The most common cause of alien hand syndrome (AHS) is infarction in the territory of the anterior cerebral artery (ACA), involving the corpus callosum, supplementary motor area, and medial frontal cortex. Three clinical variants are distinguished: frontal (object manipulation, grasping, compulsive tool use), callosal (intermanual conflict), and posterior (limb levitation, sense of foreignness). Prognosis is generally favorable - isolated lesions of the corpus callosum or cingulate gyrus usually resolve completely, whereas combined damage to the corpus callosum and frontal cortex is associated with persistent symptoms. Treatment includes pharmacological interventions (clonazepam, botulinum toxin) and rehabilitation methods (verbal cues, limb restraint, mirror therapy).

Conclusions: Alien hand syndrome is a rare but recognizable clinical manifestation of stroke requiring rapid identification to differentiate it from psychiatric disorders. Early neuroimaging assessment of the corpus callosum and frontal lobe pathways is crucial for prognosis evaluation. Further studies are necessary to establish standardized diagnostic criteria and evidence-based rehabilitation protocols.

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