Alien hand syndrome in AIDS: Neuropsychological features and physiopathological considerations based on a case report

Síndrome da mão alienígena na AIDS: características neuropsicológicas e considerações fisiopatológicas a partir de um relato de caso

Abstract

Alien hand syndrome consists of an autonomous motor activity perceived as an involuntary yet purposeful movement, with a feeling of foreignness of the involved limb, commonly associated with a failure to recognize ownership of the limb in the absence of visual cues. A 41 year old left-handed woman, HIV positive, evolved with loss of control in the left hand. Her left hand presented extravolitional movements, as if having a will of its own, not responding to commands such as opening a door or holding an umbrella, but instead groping unneeded objects. She had talked to her hand and even fought it. In addition, other clinical presentations including recent memory loss, hemineglect and dysphoria were observed. Computed tomography revealed a hypodensity area in the right frontal-parietal region, with midline deviation. Considering clinical and epidemiological data, the diagnosis of Central Nervous System (CNS) toxoplasmosis was reached. No previous reports showing association among AIDS, toxoplasmosis and alien hand syndrome were found.

Key words:
alien hand syndrome; pathophysiology; toxoplasmosis; AIDS; frontal; parietal; corpus callosum

Resumo

A síndrome da mãe alienígena caracteriza-se pela presença de atividade motora autônoma involuntária e aparentemente proposital de um membro, acompanhada de uma sensação de estranheza em relação ao mesmo, podendo associar-se a uma dificuldade em reconhecê-lo na ausência de pistas visuais. Uma paciente de 41 anos, HIV positiva, com dominância manual sinistra, evoluiu com perda do controle sobre a mão esquerda, que passou a ter "vontade própria", não obedecendo ao comando de, por exemplo, abrir uma porta ou pegar uma sombrinha, mas agarrando objetos, inúteis para a paciente no momento, que ela não conseguia soltar facilmente. Além disso, a paciente referia outras alterações, como perda de memória recente, heminegligência e disforia. A tomografia computadorizada mostrou área de hipodensidade em região fronto-parietal direita, com desvio de linha média. Considerando dados clínicos e epidemiológicos, foi estabelecido diagnóstico de neurotoxoplasmose. Não se encontram relatos da associação entre AIDS, neurotoxoplasmose, síndrome da mãe alienígena.

Palavras-chave:
síndrome da mão alienígena; neuropsicologia; fisiopatologia; neurotoxoplasmose; AIDS; frontal; parietal; corpo caloso

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Publication Dates

• Publication in this collection
  Oct-Dec 2007

History

• Received
  31 Oct 2007
• Reviewed
  16 Nov 2007
• Accepted
  25 Nov 2007