RIGHT-SIDED ANARCHIC (ALIEN) HAND: A - Pacherie - Free

15 Pages·2002·1.05 MB·English

,mgofohcysporurN Vol. 29, No. ,II .pp lll~ll27, 1991 0028-3932/91 $3.00~0.00
detnirP ni taerG .niatirB 0 1991 nomagreP sserP clp
RIGHT-SIDED ANARCHIC (ALIEN) HAND: A LONGITUDINAL
STUDY
OIGRES ALLED ?*,ALAS AILELC ~ITTEHCRAM dna SNAH ~RELNNIPS
tnemtrapeD* fo lacinilC ,ygoloisyhporueN naS oloaP ,latipsoH ;naliM ygolohcysporueNt ,tinU acinilC led
orovaL ,noitadnuoF lacideM ertneC fo ,noitatilibaheR onureV ;)ON( dna tsriFf tnemtrapeD fo ,ygolorueN
ytisrevinU fo ,naliM naS oloaP ,latipsoH naliM
(Received 29 January ;1991 accepted 2 June )1991
Abstract-A tneitap htiw a laretalib latnorf ralucsav ,noisel gnihcaorcne nopu eht laisem xetroc no
eht tfel dna egamad fo eht suproc callosum dewohs eht neila‘ ’dnah nonemonehp no eht .thgir
ehT suoirav sesehtopyh sa ot eht erutan fo eht noisel rof eht neila dnah nonemonehp ot raeppa era
.dessucsid It si desoporp taht na etuca lacinilc ,noitidnoc gniwollof a noisel fo eht suproc musollac
,ylno dluohs eb detaitnereffid morf a cinorhc noitidnoc gnitluser morf eht lanoitidda laisem-otnorf
.noisel
NOITCUDORTNI
EHT PHENOMENON dellac neila‘ ’dnah )HA( stsisnoc of the ecnerrucco of stnemevom of na
reppu bmil that are dednetninu hguohtla ylraelc detcerid ot emos .esoprup ehT ’neila‘ ,dnah
smees ot act ,ylsuomonotua gniyrrac tuo xelpmoc stnemevom tsniaga the s’tcejbus yllabrev
reported ,lliw that nac htiw,erefretni the tnempoleved of na lanoitnetni noitca that the other
dnah has .nugeb ehT tcejbus si ylluf aware of the lamronba ruoivaheb of eno dnah tub he si
ton elba ot tibihni .ti sihT si htob tnasaelpnu dna gninethgirf for .mih
stbuoD dnuoba as ot the laicurc etis of the noisel dna how egral ti has ot eb for HA ot
appear.
Interpretations based on callosal lesion only
llA the reported cases of HA that evah depoleved after ylno a lasollac noitpurretni show
the nonemonehp no the tfel edis ,l[ 9, 541. sihT was deterpretni as the tluser of the
noitcennocsid of the area detoved ot xelpmoc rotom seitivitca ni the tfel erehpsimeh
[ 17, 30, 313 morf the area no the thgir ni hcihw the rotom cortex for the tfel dnah si .detacol
sihT dluow edulcxe dednah-thgir stcejbus morf gnivah HA no the .thgir nI troppus of siht
noitaterpretni there are emos stneitap reported htiw tfel HA whose lacigoloidar-oruen
noitanimaxe deliaf ot show yna lanoitidda tnemevlovni of the lacitroc areas [26, 511.
Interpretations based on a requirement of a double, callosal and cortical, lesion
retfA [21] debircsed two stneitap htiw HA no the thgir ,edis the noitanalpxe
GOLDBERG
gnivlovni the corpus callosum (CC) ,ylno appeared etauqedani dna ti was proposed that a
sserddAS rof :ecnednopserroc snaH ,relnnipS acinilC acigolorueN I, oloP ocittadiD .S ,oloaP atisrevinU ilged
,idutS eladepsO naS oloaP alla ,anoraB aiV .A abbanatS id iniduR ,8 24102 .onaliM
III3
4111 .S ALLED .ALAS .C ITTEHCRAM dna .H RELNNIPS
elbuod ,noisel ,yleman htob fo eht CC and fo eht laisem-otnorf xetroc ,ylesicerp( fo eht
yratnemelppuS rotoM ,aerA SMA) laretalartnoc ot eht HA steem eht laitnesse lacigolohtap
tnemeriuqer fo .HA
ecniS this noitidnoc modles ,srucco ti is htrow gnibircsed hcae ,esac as this yam etubirtnoc
ot a reraelc noitinifed and noitaterpretni fo dna.HA lliw ylbissop elbane us ot poleved a
.sisylanatem eW ebircsed a raey-3 pu-wollof fo a dednah-thgir tneitap htiw lasollac and
laretalib latnorf ralucsav noisel gnitneserp htiw a elbats thgir .HA
ESAC TROPER
.C.G si a dlo-raey-65 dednah-thgir namow ohw tsrif emac ot su ni yraunaJ .8891 A raey erofeb ehs dereffus a
dionhcarabus egahrromeah dna saw detarepo no 2 syad retal ot pilc owt smsiruena fo eht roiretna gnitacinummoc
.yretra retfA ehs desuor morf a yad-02 ,amoc eht tneitap dah egaugnal sredrosid dna thgir .aigelpimeh
ehT egaugnal sredrosid noisneherpmoc( ,devreserp-llew suoenatnops hceeps ylraen ,tnetsixenon noititeper
elbissop dna )tcerroc saw elbitapmoc htiw a lacitrocsnart rotom aisahpa .emordnys ehT redrosid deraelc pu nihtiw a
wef .shtnom ehT rotom ticifed osla devorpmi dna saw lla tub enog nehw ew tsrif was .reh
nI eht tsrif shtnom retfa eht noitarepo reh laruoivaheb scitsiretcarahc dettif htob na cimanyda -citehtapa-ciluba(
)citenika dna citairom )’thcusleztiW‘( .emordnys htoB fo eseht serutaef dedisbus htiw emit dna nehw ew nageb ot
yduts .C.G ylno thgils elbats ailuba .deniamer ehS saw luftegrof ni yadyreve efil htiw a tuc-raelc ticifed fo gniogno
.yromem
sA eht rotom smotpmys deraelc ,pu ereves secnabrutsid fo noitazinagro fo yratnulov serutseg dna fo launamib
noitanidrooc emaceb .tnerappa ehT thgir dnah yltneuqerf deirrac tuo xelpmoc seitivitca taht erew ton delliw yb
.C.G esehT seitivitca erew ylraelc detcerid-laog dna erew llew ,detucexe tub derisednu yb eht ,tneitap ohw desu reh
tfel dnah ot yrt ot pots .meht roF ,elpmaxe nehw eht tneitap dah a gnimaets puc fo aet ni tnorf fo ,reh eht thgir dnah
dedeecorp ot kcip ti pu dna gnirb ti ot reh ,htuom neve hguoht eht tneitap wenk taht ti saw oot toh dna dah tsuj dias
ehs dluow tiaw a wef stnemom litnu ti dah .delooc sselehtreveN ti dedeen eht noitnevretni fo reh tfel dnah ot ecalper
eht puc no eht .elbat ehT lliw ot od os saw ton tneiciffus ot yfidom eht detcerid tub etairporppani ruoivaheb fo eht
thgir .dnah nO rehto ,snoisacco nehw .C.G dah a latineg ,hcti eht thgir dnah dehctarcs ti ,ylsuorogiv ni weiv fo rehto
,elpoep gnisuac elbaredisnoc tnemssarrabme ot eht ,tneitap ohw deirt ot pots eht thgir dnah htiw reh .tfel esehT era
ylno owt selpmaxe ynamfo hcus snoitatsefinam ,evislupmifo tnedneped-txetnoc suomonotua ruoivaheb fo eht thgir
.dnah tA rehto ,semit eht thgir dnah derefretni htiw lanoitnetni stnemevom fo eht tfel ,dnah gniyrrac tuo xelpmoc
dna dezinagro seitivitca taht did ton raeppa ot eb os ylesolc .tnedneped-txetnoc roF ,elpmaxe elihw eht tfel dnah saw
gnisu emos ,tcejbo eht thgir dnah dluow yrt ot barg ti dna esu ,ti tsniaga eht lliw fo eht ,tneitap ni emos yaw tnereffid
morf eht lanigiro .nalp ehT tneitap deredisnoc reh tfel dnah ot eb eht eno ehs dluoc ,tsurt elihw eht thgir ,dnah hcihw
dluoc ekam snoitom yletelpmoc tuohtiw reh gnitnaw ti ,ot saw eht yhtrowtsurtnu eno taht syawla‘ seod tahw ti
stnaw ot .’od ehT tneitap netfo decneirepxe siht melborp htiw eht thgir dnah gnirud reh yliad seitivitca dna ni redro
ot etelpmoc eht ytivitca ehs detnaw ot ,etelpmoc ehs dah ot tneverp eht ’drawyaw‘ thgir dnah morf ,gnirefretni
semitemos yb ecrof yb( gnittih ti ro yb gnittis no .)ti ehT deen ot ekat eseht ,snoituacerp hcihw dah ylno gniteelf
,stceffe dna eht tneuqerf seruliaf decudorp a dekram gnileef fo .noitartsurf nI etips fo eht secneinevnocni desuac yb
siht rotom ruoivaheb fo eht thgir ,dnah .C.G reven deined neve( ni esnopser ot tcerid )gninoitseuq taht siht ’neila‘
dnah degnoleb ot reh .e.i( ehs dah on ngis fo .)aisongotamosa ehS reven dah a desserped ro suoixna ,noitcaer tub saw
rehtar deyonna yb reh .smotpmys ehS saw llew erawa fo eht melborp dna taht eht ecnabrutsid detsisnoc ylevisulcxe
fo eht dnah-thgir gninoitcnuf ylsuomonotua tsniaga reh .lliw
Neurological examination
ehT lacigoloruen noitanimaxe ni yraunaJ 8891 .e.i( a raey retfa eht erutpur fo eht )msiruena dewohs thgils siserap
fo eht thgir ,sbmil hcihw dluoc llits yrrac tuo lla eht .stnemevom stnemevoM rof gnihcaer ro gnikcip pu stcejbo
decalp ni eht lanosrep-irep ecaps erew .lamron dednah-owT ,sksat neve ylevitaler xelpmoc seno .g.e( gnikam a
,egakcap gnidlof a rettel dna gnicalp ti ni na ,)epolevne erew enod yltcerroc dna htiw doog noitanidrooc fo eht owt
.sdnah noitasneS saw lamron ni lla .seitiladom ehT thgir dnah dewohs cinot ;gnipsarg ereht erew on rehto lacitroc
noitibihnisid sngis ro noitarevesrep fo rotom .stca
Neuroradiology
ehT TC nacs deirrac tuo ni yaM ,7891 dewohs a laretalib lasab-otnorf naidemarap ,ytisnedopyh gnivlovni eht
roiretna trap fo eht CC dna gnidnetxe erom ot eht tfel os sa ot ylbamuserp hcaorcne nopu eht yratnemelppus rotom
aera fo taht edis .giF( .)1 sihT dluoc ton eb demrifnoc yb raelcuN citengaM ecnanoseR esuaceb fo eht latem spilc ni
eht s’tneitap .daeh
RIGHT-SIDED ANARCHIC (ALIEN) HAND: A LONGITUDINAL STUDY

RIGHT-SIDED ANARCHIC (ALIEN)HAND: A LONGITUDINAL STUDY 7111
Neuropsychological examination
A dradnats egaugnal ,noitanimaxe eht renehcaA eisahpA Test [ 133,41 yraunaJ( ,)8891 dewohs on cisahpa .ticifed
gnitirW htiw eht thgir dnah saw .lamron rehtieN gnitirw ron gniward decnedive .noitarevesrep
ehT lacigolohcysporuen noitanimaxe (see elbaT ,1 tsrif )noisses dedulcxe labolg evitingoc .noitaroireted erehT
erew yromem sticifed taht did ton tif otni yna lacissalc aisenma ,emordnys gnivlovni htob mret-trohs dna mret-gnol
laitaps dna labrev .yromem lacihpargoibotuA yromem saw osla ;deriapmi .C.G did ton ,ecudorp ,revewoh
.snoitalubafnoc ehT tneitap derocs woleb eht sffo-tuc ni emos stset lgieW( gnitroS ,tseT nrohtilE lautpecreP )ezaM
,511 135 taht era yllanoitidart deredisnoc ot eb evitisnes secidni fo latnorf egamad .]84[
The alien hand
ehT epatoediv-oidua of the test snoisses was detaulave yb two tnednepedni .srevresbo
gniruD emos of the lacigolohcysporuen tests hcihw deriuqer noitalupinam or noitazilitu of
,stcejbo a tcilfnoc neewteb the two sdnah emaceb ,tnedive htiw each of meht gnitca gnidrocca
ot separate dna netfo gnitepmoc .semmargorp ehT tneitap syawla tlef that the thgir dnah was
a gnibrutsid ,tnemele neve nehw ti deirrac tuo na ytivitca erom yletauqeda naht the .tfel ehT
gnileef that the stnemevom of the thgir dnah were gnibrutsid appeared ot esira morf the fact
that the tneitap ylsuoicsnoc delliw (as was raelc morf her nekops )snoitpircsed ylno what the
tfel dnah was ,gniod elihw what the thgir dnah was gniod was syawla .detcepxenu ehT
seitivitca of the thgir dnah did ton nessel nehw the mra was devom revo the enildim ot the tfel
,ecapsimeh as yeht did ni tneitap B.D. debircsed yb GREBDLOG ,]32[ gnitseggus that ruo case
did ton evah laitapsimeh‘ rotom ’tcelgen [37].
erehT were ynam lasollac‘ ;’anemonehp yeht are detsil ni elbaT 2. revenehW ,elbissop we
desu the ygolonimret of NEGOB [9].
(1) cisahpA errors nehw gnitirw htiw the tfel dnah ni esnopser ot noitatcid cisahpa(
aihparga of the tfel )dnah .giF( 2). ehT tneitap flesreh was aware of these errors dna was
desirprus yb ,meht tub dluoc ton correct meht htiw the tfel .dnah
(2) Errors of gniman stcejbo decalp ni the tfel dnah dna detalupinam tuohtiw lausiv
lortnoc elitcat( aimona of the tfel :)dnah a nep was dellac a ,efink a yek was dellac a ,noops a
dnab was dellac a sinnet racket, a fork a ,noops a gnir a .dil ehT stcejbo were detalupinam
yltcerroc dna yeht were ,dezingocer hguoht ton ,deman nehw retal detneserp dexim htiw wen
.stcejbo stcejbO were deman yltcerroc nehw detalupinam yb the thgir .dnah
(3) labreV orders detucexe yb the tfel dnah were evitcefed aixarpa( of the tfel )dnah htob
nehw .C.G was asked ot emim the noitca tuohtiw gnisu the laer tcejbo dna nehw she was
asked ot yrrac tuo erutseg tuohtiw ecnacifingis or lufgninaem serutseg (e.g. ekam the ngis of
the cross, evig a yratilim ,etulas etc.).
(4) ylevitaleR elpmis citemhtira ,snoitaluclac hcihw dluoc semitemos eb demrofrep
yllufsseccus ,yllacov were yltneuqerf suoenorre nehw nettirw laitaps( .)ailuclacsid
(5) A lacirtemoeg erugif was deipoc yltcerroc yb htob ,sdnah tub the snoitroporp dna
snoisnemid were resolc ot those of the lanigiro ni the ypoc edam htiw the tfel .dnah
(6) refsnarT of citehtsenik noitamrofni morf eno mra ot the other edistuo the lausiv lortnoc
(for ,elpmaxe mra dednetxe htiw the mraerof dexelf dna the desolc tsif decalp no the
laretalomoh )redluohs was yllautriv elbissopmi for htob the tfel dna thgir edis (9 seruliaf ni 10
,slasoporp whether morf thgir ot tfel or tfel ot .)thgir
Follow-up
G.C’s HA dezilibats revo ,emit hcihw detutitsnoc a cinorhc thgir .HA ehT tneitap flesreh
dias that ti appeared nihtiw 2 shtnom after her yrevocer morf evitarepotsop amoc dna we
devresbo ti for the tsrif emit 1 raey .retal ehT ngis had ton degnahc at na noitanimaxe 2 sraey
.retal
8111 .S ALLED ,ALAS .C ITTEHCRAM dna .H RELNNIPS
ELBAT .1 s’CC ecnamrofrep ni a lamrof cirtemohcysp yrettab dna yhtlaeh .senilesab llA serocs evah neeb
detsujda rof ,ega noitacude dna .xes egnaR ni .stekcarb ehT stset dezilitu era debircsed ni RELNNIPS dna
INONGOT ]74[ tpecxe rof eht tset rof esorp yromem ,]S[ eht tset fo lacihpargoibotua yromem ]ol[ dna eht tset
fo eht srewoT fo ionaH ]2[
G.C:s
detsujda
s’C.G serocs dn2(
detsujda ,noisses ’slortnoC
serocs ts1( lavretni = laitnerefni ’slortnoC
)noisses 92 )shtnom ht5 elitnec naidem erocs
lortnoC snoitcnuf
noitnettA *03 5.14 03 94
evitceleS :noitnetta
tigiD noitallecnac tset )06r((
detrevnI gniypoc fo serutseg (&24) 42 52.71 52.81 52.32
ecnegilletnI dna evitucexe snoitcnuf
labreV tnemegduj (t&60) 52.34 52.85 23 05
s’nevaR evissergorp secirtam tes ,A ,B ,C 57.61 57.02 57.41 57.82
D )8w(
s’lgieW gnitros tset )51-O( 2* 4* 52.4 57.01
s’nrohtilE lautpecrep ezam tset 0* s57.4 52.7 52.41
srewoT fo ionaH tset )08.81r(( 68.71 20.81 9 81
ycneulF no citnames euc )fni&( 57.9 52.21 7 71
eerF drow noitaicossa )fni%t( 52.4 57.7 51.3 05.9
Instrumental functions
yromeM
labreV drawrof naps )fni%t( *05.2 5.3 57.2 05.4
laitapS drawrof naps )01-O( 3* 5 M.3 57.4
naps-arpuS labrev gninrael 8* 04 63 111
s’dluF-ekhcsuB evitceles gnidnimer
euqinhcet )0816(
naps-arpuS laitaps gninrael s’isroC( test) *52.5 70.9 05.6 02
)61.92G(
laireS noitisop evruc
ycamirP )07G( 21 7 05.4 05.51
ycneceR )03-O( 05.lI 05.61 05.7 05.81
esorP yromem )051&( 3* 6* 42 06
lacihpargoibotuA yromem (&45) *41 91 83
egaugnaL
nekoT tset (&36) 51.62 52.23 52.62 33
ecnetneS noitareneg morf owt detalernu 41 41 52.6 57.31
snuon )81-O(
sixarP
rotomoedI aixarpa
thgiR dnah )27-O( 26 26 25 96
tfeL dnah (&72) *25 65 25 96
lausiV noitpecrep
htgneL fo tnemges noitanimircsid )23-O( 12 62 71 62
slwarcS noitanimircsid (t&32) 32 91 57.02 52.13
s’teertS noitelpmoc tset (&14) 05.7 5.8 2 52.7
lacigolohtaP* ,erocs .e.i woleb eht ht5 elitnec fo eht lamron .noitubirtsid
DEDIS-THGIR CIHCRANA )NEILA( :DNAH A LANIDUTIGNOL STUDY 9111
ELBAT .2 s‘.C.G ecnamrofrep ni sksat desived ot wohs a lasollac emordnys
thgiR dnah tfeL dnah
aihpargA oN seY
elitcaT aimona 0l/OI 0l/S
rotomoedI aixarpa ni esnopser ot labrev
:dnammoc
dneterP tcejbo noitazilitu 0119 01/o
evisnartnI stnemevom 01/5.9 0117
lufgninaeM serutseg Ol/Ol 0115.4
lanoitcurtsnoC aixarpa 41/41 41141
laitapS ailuclaca seY
noitacilper-ssorC fo mra dna dnah serutsop
tuo fo lausiv lortnoc 0l/l 01/l
ehT tneitap was ton elba ot dnif seigetarts that dluow diova or stop the tcilfnoc neewteb the
two ,sdnah hcihw dluoc eb devloser ylno yliraropmet yb gnisu force. nevE the noitseggus
[21,23] that she dluohs klat‘ ot the ’dnah did ton evorp .evitceffe
eerhT sraey after the dionhcarabus ,egahrromeh lla the sngis of lasollac noitcennocsid that
we evah debircsed were llits .tneserp ehT rotomoedi aixarpa no noitatimi ,]Sl[ of the tfel
,dnah nees ni the tsrif ,noitanimaxe had devorpmi ylbaeciton elbaT( 1). ehT evitingoc eliforp
showed dekram tnemevorpmi ni yromem noitcnuf dna laitrap tnemevorpmi ni the dellac-os
latnorf tests elbaT( 1). ,revewoH there was llits yadyreve ecnedive of secnabrutsid of gniogno
yromem dna her ruoivaheb deirav neewteb aitreni dna .ssensuoitecaf
NOISSUCSID
The anarchic hand
ruO tneitap htiw cinorhc dedis-thgir HA had na evisnetxe noisel of the corpus callosum
(CC) dna the laisem-otnorf cortex no htob .sedis tI si elbanosaer ot kniht that the
yratnemelppus rotom area )AMS( was erom ylekil ot eb desimorpmoc no the ,tfel nevig the
regral laisem noisel no that .edis ehT seitivitca of the thgir dnah were deredisnoc yb the
tneitap ot eb ,detnawnu dna siht gnileef did ton egnahc htiw .emit ehT suomonotua
stnemevom were correct morf the cixarp ,tniopweiv yeht were rehtien sselmia ron ,cixata ton
elbaifitnedi as .saiseniksyd ehT tneitap dewovasid the stnemevom deirrac tuo yb the thgir
dnah neve nehw yeht tif the stnemeriuqer of the tasks deirrac .tuo sihT ruoivaheb tonnac eb
deterpretni as the ecneuqesnoc of cirehpsimeh evitingoc ecnetepmocni for emos sesnopser of
the thgir ,dnah as was deredisnoc ot eb the case for GNIROL et al.? case J.M. [32].
.C.G reven deredisnoc that the HA that she dluoc ton lortnoc was ton yllaer ;sreh ni fact, as
ni tsom cases ni the ,erutaretil she syawla dezingocer the mra as hers. eW agree htiw
GREBDLOG ]32[ that the mret neila‘ ’dnah si ssel etairporppa naht the mret drawyaw‘ ’dnah
or, ni weiv of the etelpmoc ymonotua of the mra dna sti evitpursid effect no the yliad seitivitca
of stneitap who evah ,eno perhaps the tseb dluow eb cihcrana‘ .’dnah
ehT noitaterpretni of HA si edam detacilpmoc neve yb citsiugnil .gnidnatsrednusim sihT
emas mret has neeb desu ot ebircsed anemonehp that evah elttil ni .nommoc BOGEN[9], for
,elpmaxe denifed HA as a dnah that sevaheb‘ ni a yaw hcihw the tneitap sdnif ngierof or at
tsael ’evitarepoocnu (p. 313) ,dna htiw tsomla elbitpecrepmi shades of ,gninaem -nereffid
setait siht morf launamretni‘ ’tcilfnoc (p. 312), denifed as a noitautis ni hcihw eno dnah si‘
gnitca at cross sesoprup ot the other’, semitemos ot the tniop of gnigagne ni a laer elggurts
.S ALLED ,ALAS .C ITTEHCRAM dna .H RELNNIPS
.GIF .2 emoS selpmaxe fo sdrow nettirw yb .C.G htiw eht tfel .dnah nI noitidda ot eht elbanosaer
ssenismulc eud ot kcal fo ecneirepxe ni gnitirw htiw eht tnanimodnon ,dnah ereht era ynam suoivbo
.saihpargarap It si yhtroweton taht lla gnitluser sesnopser era .sdrow-non ehT tneitap yltcerroc daer
tahw ehs dah ylgnorw ,nettirw tub saw ton elba ot tcerroc ti ,yllacihparg htiw eht tfel .dnah
htiw the other, dna morf ,’msicitircotua‘ hcihw stsisnoc of na noisserpxe‘ of ’tnemhsinotsa
(p. 313) yb the tneitap who sees that eno dnah appears ot eb dedivorp htiw sti nwo
suomonotua noitilov dna refers ot ti as ti si ton nevird yb sih :lliw ‘the dnah did hcus dna
.’hcus
nI gniweiver suoiverp reports, ti snrut tuo that the denoitnem-evoba smret are netfo desu
ylbaegnahcretni for yrev tnereffid :snoitautis suoenatnops dna yratnulovni gnipsarg yb eno
dnah of gnihtyreve raen ti htiw( a deen for the other dnah ot enevretni ot stop ti morf gnikat
pu sgniht that the tcejbus does ton )tnaw [24, 353, noitnevretni of eno dnah ot correct
seitivitca that are or are deredisnoc ot eb gnorw [32], the ecneirepxe of the ytilibissopmi of
gnitrexe yratnulov lortnoc of detanidroocnu stnemevom yb eno dnah ni the case of citpo
RI~HT-~DED ANARCHIC (ALIEN) HAND: A LONGITUDINAL STUDY 1121
aixata [29] or neve the yratnulovni stnemevom of eno dnah gnirud the esruoc of lasabocitroc
noitareneged [20,40,41].
yllausU these anemonehp are debircsed nihtiw detageirav erutcip of etuca -simehretni
cirehp noitcennocsid smotpmys dna yeht are yllausu detaler ot the niaM‘ ’ehgnartE Of
ORION
dna KANYDEJ l[ ]l or ot the citsongaiD‘ ’aixarpsyD of SITIALEKA .]l[ ,revewoH there are
suoivbo .secnereffid ehT main ttrangdre debircsed yb NOIRB dna KANYDEJ [ 1 ]l detsisnoc of a
kcal of noitingocer yb the tcejbus of sih or her tfel dnah nehw asked ot hcuot ti htiw the thgir
dnah tuohtiw lausiv .lortnoc tahT ,si the stneitap dezingocer eno ,dnah tub were ton aware
that yeht were gnilaed htiw rieht nwo tfel ,dnah ni a dnik of aisongaotamosimeh detimil ot
the dnah dna ot the elitcat ytiladom .ylno No stnemevom that were ton yratnulov dna ton
dellortnoc yb the tcejbus were dedulcni ni siht .erutcip ehT citsongaiD‘ ’aixarpsyD of
SITIALEKA ]l[ ,detsisnoc ,daetsni of a gniteelf ,ecnaraeppa gnirud the short doirep
yletaidemmi gniwollof a ,ymotosollac of rotom ytivitca that detcidartnoc what the tcejbus
detnaw ot do. sihT nonemonehp appeared ni the tneitap as a gnorts tcilfnoc neewteb the two
,sdnah htiw the tfel dnah yllacitametsys gniodnu what the thgir dnah had tsuj dehsinif .gniod
Anatomo-functional correlating hypothesis fo AH
elbaT 3 sezirammus the noitamrofni tuoba ynam of the stneitap htiw HA debircsed ni the
.erutaretil tI osla sedulcni cases for mohw ti si ton elbissop ot speak of HA ni the tcirts ,esnes
tub who had eno or erom of the anemonehp detaicossa htiw .ti erehT si na evisnetxe esenapaJ
erutaretil that has ton neeb denoitnem no the ;elbat the reader si referred ot a tnecer paper yb
AKANAT et al. [49].
eW deredisnoc ti lufesu ot edulcni the tsegral tnuoma of lacinilc noitamrofni for each
tneitap ni siht .elbat noitubirttA of a nevig motpmys ot a tneitap was desab no the noitpircsed
of the srohtua rather naht no what yeht deman the .motpmys nehW the srohtua did ton
edulcni hguone noitamrofni ot ekam siht elbissop (e.g. NAHC et al. [ 12]), we desu the mret the
srohtua had .desu eW desu the denoitnem-evoba snoitinifed of NEGOB [9] for ,HA
launamretni tcilfnoc dna .msicitircotua yB rorrim‘ ’stnemevom we naem snoitautis ni hcihw
htob smra tonnac yrrac tuo tnereffid dna yratnemelpmoc seitivitca ,ylsuoinomrah tub are
dnuob ot rorrim each other. ehT lasollac‘ ’sngis are those ylnommoc reported for the
emordnys of cirehpsimehretni noitcennocsid (see ,NEGOB 1979 [9]). nI ,liated for the stneitap
deredisnoc ni elbaT 3 yeht :erew elitcat aimona of the tfel dnah [8, ,315-94,63,82,62,42,11
aixarpa of the tfel dnah [8, 12,24,26,36,51], aihparga of the tfel dnah [8,11,12,26,28,36,
511, thgir evitcurtsnoc aixarpa ,ll[ 25,28,51], tfel evitaler aisponaimeh-oduesp [ 111, kcal of
ytiliba ni gnitacilper-ssorc dnah serutsop ,ll[ 12, 281, noitcnitxe ni citohcid gniraeh of
ilumits detneserp ot the tfel ear [25], laitaps ailuclacsid [28] dna aimona for stcejbo
detneserp ni the tfel lausiv dleif [4]. ehT tneitap debircsed yb INAHAHS [45] si ton set forth ni
elbaT 3 hcumsani as he did ton tneserp htiw tuc-raelc neila .ruoivaheb sihT si at odds htiw
the tneuqerf report of siht case [21] gnoma the ’neila‘ .secnerefer
gnisylanA the data ni elbaT 3, ti si elbissop ot etalumrof emos gnizilacol sesehtopyh morf
the erutaretil no ,HA sesehtopyh ydaerla denoitnem ni the .noitcudortnI
(1) ehT sisehtopyh that a debircsmucric noisel of the CC si tneiciffus si desab yllaitnesse no
the fact that the tseilrae snoitpircsed of HA were edam after lacigrus ymotosollac dna the
nonemonehp was dnuof gnola htiw sngis of etuca cirehpsimehretni noitcennocsid [ 1,9,54].
sihT sisehtopyh demees ot evah neeb demrifnoc yb emos cases htiw ralucsav snoisel [6,28,
511 hcihw did ton evah lacitroc snoisel that dluoc eb detected yb lacigoloidaroruen .sdohtem
Cases htiw tfel HA tif nihtiw a laciteroeht ,noitanalpxe gnimmets morf the aixarpa ,niamod
1122 OIGRES ALLED ,ALAS AILELC ITTEHCRAM and HANS R ELNNIPS
ELBAT 3. tuo-yaL fo sgnidnif reported ni 35 stneitap gnitneserp neila‘ hand’ and/or mnin twang&e, launamretni
noiseL
,SITIALEKA 1944 [I] I lacigruS noisivid fo body and roiretsop flah fo uneg fo
the CC
NOIRB id ,KANIUEJ 1972 I[ ]I I lasollaC tumor
2 lasollaC f”mOrS
1 tfeL lasollacirep an&ma
NosLlW et ,.lo 1977 1541 1 lacigruS noisivid fo the CC
TEZIBRAB et al., 1978 [4] I lacinilC sisongwd fo avafaihcraM imangiB dxase +
NAMLEWUEB er al., 1980 [S] I :TC dehsinimid ytisned between the anterior horns fo +
the laretal selcirtnev
;cn~eu~oG et al., 1981 ]lZ[ 1 :TC tfel laisem-otnorf cortex noitcrafni R + IR( + CR)
1 :TC tfel laisem-otnorf cortex noitcrafni R + IR( + CR)
NOSTAW & NAMLIEH 1963 [51] 1 :TC hemorrhage gnidnetxe morf the uneg ot the R
muineps fo the .CC lanoroC reconstructions showed
siht ot extend evoba the CC
OREBNEOLOG er ,.lo 1985 [24] 1 :lC noitcrafni fo the anterior two sdriht fo the .CC fo R + )LIB( + )L(
htob etalugnic iryg and the etihw matter hnivlrednu the
upper and laisem parts fo latnorf sebol
NOSTAW et al., 1986 [52] I :TC wol vtisned fo the tfel laisem hemisohere and eenu + (RI + (R) + IR(
and anterior body fo the CC
1 :TC wol ytisned ni the noitubirtsid fo the tfel anterior + IR(
cerebral artery ton gnivlovnI the CC
ENIVEL k ,NNIR 1986 1291 1 :TC egral thgir lasab latipaco-oropmet and llams -nev
lart laretal-oretsop cimalaht stcrafni
,GREBDLOG 1987 [23] I CT, :RMN evisnetxe noitcrafni fo the laisem surface fo R + CL) + CL) + +
the thgir latnorf ebol and fo the body fo the CC
DROFDAR-TFARG or al., 1987 [26] I :RMN hemorrhage ni the uneg and tsom fo the body fo R
the :CC no ecnedive fo noitcrafni ni the AMS
INANGAM er al., 1987 [35] I :TC reduced ytisned ni the laisem face fo the tfel + CR) + CR)
hemisphere, two sdriht fo the anterior noitrop fo the
CC and part fo the lateirap ebol
1 :TC recent cimehcsi noisel fo the etihw matter ni the + )LIB( + )LIB(
tfel laisem-otnorf ;noiger a suoiverp noisel ni the tfel
caudate suelcun and lacitroc atrophy
BBANCM et al., 1988 [36] 1 :TC evisnetxe noitcrafni fo the tfel suoerior. -otnorf R + CR) + CR) noitanidrooC
l&em and lateirap cortex and fo unegeht and body fo smelborp
cc
1 No noitamrofni noitanidrooC +
smelborp
I + (R) + IR( noitanidrooC ?+
smelborp
NAHC B ,ssoR 1988 12I[ 1 :TC cimehcsi ooltcrafni gnivlovni thgir anterior _ _
etaluanic wrus and .AMS CC vlno vllaminim devlovni
3 :TC noitcrafni on the tfel ,AMS anterior e&g& + IR( _ +
suryg and anterior CC
1 :TC noitcrafni ni the thgir ,AMS anterior etalugnic + )L( _ +
soryg and anterior CC
1 :TC noitcrafni m the thair ,AMS anterior etaluenic + )L( _
suryg and anterior -CC
SKNAB er of.. 1989 [3] 1 :vsootuA _ laretalib latnorf damaee _ (z on the their _ 1edis + )L( +
and lasollac ;egamad lanoitidda damage on the thgir
lasab ailgnag and sumalaht
1 :TC hemorrhage ni the laisem-otnorf sebol :vllaretalib R
damage ot unegeht and anterior noitrop fo the .CC
AunnuctEL er al.. 1989 [28] 1 :TC hemorrhage enivlovni the CC morf the dorso- R + IR( +
rostra1 noitisop fo the &g ot the tsom caudal part fo
the body
1 CT. hemorrhage gmdnetxe morf the lasrod part fo the + )LIB( +
uneg ot the caudal driht fo the CC
1 :TC evisnetxe hemorrhage morf the rostra1 Dart fo the + (R) + )L( +
uneg ot the lasrod muinelps fo the CC
wlnoL I lacieruS noitces fo the CC +
:RGN noisivid fo the ,CC no lanoitidda noisel
1 :RMN llams cimehcsi stroke fo the anterior two-thuds t 2(
fo the CC fo the etalugnic suryg and fo the laisem
roirepus latnorf suryg fo htob hemispheres sAMS(
demialc 10 be spared)
I :TC bdateral latnorf noitcrafni gnivlovni the .CC On IR( -
the tfel ,edis noisel gnidnetxe ot AMS
J : ngiS :tneserp - : ngis absent; :?+ elbanoitseuq ngis presence: :)R( ;dedis-&n :)L( ;dedis-tfel :)LIB( yllaretalib ;dedis :A :suortxedibma :*)R(
the thgir hand osla yllanorsacco showed ahen behawour.