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Stroke with supernumerary phantom limb: case study, review of literature and pathogenesis

Published online by Cambridge University Press:  24 June 2014

Abhishek Srivastava ,
Arun B. Taly ,
Anupam Gupta ,
Thyloth Murali ,
Mohan L. Noone ,
Jagadisha Thirthahalli ,
B. N. Gangadhar ,
J. Keshav Kumar  and
P. N. Jayakumar
Abhishek Srivastava*
Affiliation:
Department of Psychiatric and Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
Arun B. Taly
Affiliation:
Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
Anupam Gupta
Affiliation:
Department of Psychiatric and Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
Thyloth Murali
Affiliation:
Department of Psychiatric and Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
Mohan L. Noone
Affiliation:
Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
Jagadisha Thirthahalli
Affiliation:
Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
B. N. Gangadhar
Affiliation:
Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
J. Keshav Kumar
Affiliation:
Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India Department of Mental Health and Social Psychology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
P. N. Jayakumar
Affiliation:
Department of Neuro Imaging and Intervention Radiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
*
Department of Psychiatric and Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bangalore 560029, Karnataka, India. Tel: 91-080-26995287 (0); Mobile: 91-9880518070; Fax: 91-080-26564830; E-mail: [email protected]
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Abstract

Objective:

Constitute hypothesis for origin of supernumerary phantom limb (SPL) after stroke.

Method:

Single case description, review of literature and formulation of hypothesis.

Results:

A 59-year-old lady was evaluated for complaints of left-sided hemiparesis and extra limbs attached to her left shoulder for the past 7 months. Neuropsychological assessment revealed left hemineglect with SPL, and profile suggested bilateral frontal, right parietotemporal and basal ganglia involvement. Magnetic resonance imaging brain scan showed gliotic cavity secondary to the old haematoma in right putamen with white matter changes in the right frontoparietotemporal lobes.

Conclusions:

The conceptual framework of body schema can be used to classify many of the neurological disorders of body representation. Generation of SPL comes under the subtype of pathology of updating among the disorders of body schema. The continuous updating allows the body schema to modulate perceptual processing of objects according to their position in space. Brain areas classified as parts of motor system can, under pathological conditions (haemorrhage), influence body perception. So, when she used to move her arm, the representation of the estimated position was not updated by the motor commands. Sensory and motor information therefore becomes discrepant, and failure to integrate these two sources of information leads to loss of normal coherence, and the perceived shape of the body was altered by adding a SPL to accommodate the discrepancy.

Keywords

basal gangliabody schemahemiparesisintracerebral haemorrhagestrokesupernumerary phantom limb
Type
Research Article
Information
Acta Neuropsychiatrica , Volume 20 , Issue 5 , October 2008 , pp. 256 - 264
Copyright
Copyright © 2008 Blackwell Munksgaard

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References

McGlynn, S, Schacter, D. Unawareness of deficits in neuropsychological syndromes. J Clin Exp Neuropsychol 1989;11:43–205. CrossRefGoogle ScholarPubMed
Brian, S, Jedyank, CP. Disorders of inter-hemispheric transfers (callosal disconnection). Three cases of tumor of the corpus callosum: The strange hand sign. Rev Neurol 1972;126:257–266. Google Scholar
Critchley, M. The parietal lobes. New York: Hafner, 1953:243–244. Google Scholar
Fredericks, J. Phantom limb and phantom limb pain. In: Fredericks, J, ed. Handbook of clinical neurology, Vol. 1. Amsterdam: Elsiever, 1985:373–393. Google Scholar
Melzack, R. Phantom limbs and the concept of neuromatrix. Trends Neurosci 1990;13:88–92. CrossRefGoogle ScholarPubMed
Bakheit, AMO, Roundhill, S. Supernumerary phantom limb after stroke. Postgrad Med J 2005;81:953–955. CrossRefGoogle ScholarPubMed
Cutting, J. Body image disturbances in neuropsychiatry. In: Reynolds, E, Trimble, M, eds. The bridge between neurology and psychiatry. Edinburgh: Churchill Livingstone, 1989. Google Scholar
Head, H, Holmes, G. Sensory disturbances from cerebral lesions. Brain 1911;34:102–254. CrossRefGoogle Scholar
Appenzeller, O, Bicknell, J. Effects of nervous system lesions on phantom experience in amputees. Neurology 1969;19:141–146. CrossRefGoogle ScholarPubMed
Fredericks, H. Occurrence and nature of phantom limb phenomenon following amputation of body parts and following lesions of the central and peripheral nervous system. Psychiatr Neurol Neurochir 1963;66:73–97. Google Scholar
Canavero, S, Bonicalzi, V, Castellano, G, Perozzo, P, Massa-Micon, B. Painful supernumerary phantom arm following motor cortex stimulation for central post stroke pain. J Neurosurg 1999;91:121–123. CrossRefGoogle Scholar
Halligan, PW, Marshall, JC. Supernumerary phantom limb after right hemispheric stroke. J Neurol Neurosurg Psychiatry 1995;59:341–342. CrossRefGoogle ScholarPubMed
Halligan, PW, Marshall, JC, Wade, DT. Three arms: a case study of supernumerary phantom limb after hemispheric stroke. J Neurol Neurosurg Psychiatry 1993;56:159–166. CrossRefGoogle Scholar
Halligan, PW, Cockburn, J, Wilson, B. The behavioral assessment of visual neglect. Neuropsychol Rehabil 1991;1:5–32. CrossRefGoogle Scholar
Gregson, JM, Leathley, M, Moore, AP, Sharma, AK, Smith, TL, Watkins, CL. Reliability of the Tone Assessment Scale and the Modified Ashworth Scale as clinical tools for assessing post stroke spasticity. Arch Phys Med Rehabil 1999;80:1013–1016. CrossRefGoogle Scholar
Folstein, M, Folstein, SE, McHugh, PR. “Mini-mental state” a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198. CrossRefGoogle ScholarPubMed
Rao, SL, Subbakrishna, BK, Gopu-Kumar, K. NIMHANS neuropsychological battery: manual, 1st edn. Bangalore: NIMHANS Publication, 2004. Google Scholar
Pinaes, H. Ein Fall von phantomahnlichen Erscheinungen (“Phantom arm”) bei hemiplegischer Lahmung. Nervenarzt 1932;5:233–236. Google Scholar
Bogaert, LV. Sur la pathologie de l’image de soi. Ann Med Psychol 1934;92:519–536. Google Scholar
Ehrenwald, H. Verandeteres Erleben des Korperbildes mit konsekutiver Wahnbildung bei linkseitiger Hemiplegie. Monatsschr Psychiatr Neurol 1930;75:89–97. CrossRefGoogle Scholar
Hecaen, H, Ajuriaguearra, J, Angelergues, R. D’elire centr’e sur un member-fantome chez une h’emiple’gique gauche par l’esion vasculaire avec mosignosie. Evol Psychiatr (Paris) 1952;2:273–279. Google Scholar
Gilliatt, R, Pratt, R. Disorders of perception and performance in a case of right sided cerebral thrombosis. J Neurol Neurosurg Psychiatry 1962;15:264–271. CrossRefGoogle Scholar
Weistein, EA, Kahn, RL, Malitz, S, Rozanski, J. Delusional reduplication of parts of the body. Brain 1954;77:45–60. CrossRefGoogle Scholar
Brock, S, Merwarth, HR. The illusionary awareness of body parts in cerebral disease. Arch Neurol Psychiatry 1956;77:366–370. CrossRefGoogle Scholar
Hohjoh, T, Ohyama, H, Watanabe, S. Asomatognosia and anosognosia. In: Yamadori, S, ed. Neuropsychiatry and image diagnosis, Vol. 2. Tokyo: Asakura Shoin, 1989: 218–225. Google Scholar
Sellal, F, Renaseau-Leclerc, C, Labrecque, R. The man with six arms: an analysis of supernumerary phantom limb after right hemispheric stroke. Rev Neurol 1996;152:190–195. Google Scholar
Worthington, A, Beevers, L. Two arms, three hands: a supernumerary phantom phenomenon after right middle cerebral artery stroke. Neurocase 1996;2:135–140. Google Scholar
Donnet, A, Schimtt, A, Poncet, M, Graziani, N, Grisoli, F. Hallucinations of supernumerary limbs, left hemineglect and hypersexuality in a case of right capsule-lenticular haematoma. Rev Neurol 1997;153:587–590. Google Scholar
Mazzoni, M, Lucchini, C, Meucci, G, Vista, M, Moretti, P, Sartucci, F. Replication: supernumerary phantom limb after ischemic stroke. Neurocase 1997;3:223–230. CrossRefGoogle Scholar
Hari, R, Hanninen, R, Makinen, Tet al. Three hands: fragmentation of human bodily awareness. Neurosci Lett 1998;24:131–134. CrossRefGoogle Scholar
Miyazawa, N, Hayashi, M, Komiya, K, Akiyama, I. Supernumerary phantom limbs associated with left hemispheric stroke: case report and review of literature. Neurosurgery 2004;54:228–231. CrossRefGoogle Scholar
Vuilleumier, P, Reverdin, A, Landis, T. Four legs: illusionary reduplication of the lower limbs after bilateral parietal lobe damage. Arch Neurol 1997;54:1543–1547. CrossRefGoogle Scholar
Canavero, S. Dynamic reverberation: a unified mechanism for central and phantom pain. Med Hypotheses 1994;42:203–207. CrossRefGoogle ScholarPubMed
Fischer, K, Hanspal, RS. Phanton pain, anxiety, depression, and their relation in consecutive patients with amputed limbs: case reports. Br Med J 1998;316:903–904. CrossRefGoogle Scholar
Canavero, S, Bonicalzi, V. Pain after thalamic stroke: right diencephalic predominance and clinical features in 180 patients. Neurology 1998;51:927–928. CrossRefGoogle ScholarPubMed
Riddoch, G. Phantom limbs and body shape. Brain 1942;64:197–222. CrossRefGoogle Scholar
Levine, D, Calvanio, R, Rinn, W. The pathology of anosognosia for hemiplegia. Neurology 1991;41:1770–1781. CrossRefGoogle Scholar
Damasio, A, Damasio, H, Chang Chui, H. Neglect following damage to frontal lobe or basal ganglia. Neuropsychologia 1980;18:123–132. CrossRefGoogle ScholarPubMed
Sperber, D, Wilson, D. Relevance: communication and cognition. Oxford: Blackwell, 1986. Google Scholar
Frith, CD, Blakemore, SJ, Wolpert, DM. Abnormalities in the awareness and control of action. Philos Trans R Soc Lond B Biol Sci 2000;355:1771–1788. CrossRefGoogle ScholarPubMed
Wolpert, DM, Kawato, M. Multiple paired forward and inverse models for motor control. Neural Netw 1998;11:1317–1329. CrossRefGoogle ScholarPubMed
Ramachandran, VS, Hirstein, W. The perception of phantom limbs. Brain 1998;121:1603–1630. CrossRefGoogle ScholarPubMed
Ramachandran, VS, Rogers-Ramachandran, D, Stewart, M. Perceptual correlates of massive cortical reorganization. Science 1992;258:1159–1160. CrossRefGoogle ScholarPubMed
Kew, JJM, Halligan, PW, Marshall, JCet al. Abnormal access of axial vibrotactile input to deafferented somatosensory cortex in human upper limb amputees. J Neurophysiol 1997;77:2753–2764. CrossRefGoogle ScholarPubMed
Cole, JD. Pride and a daily marathon. London: Duckworth, 1991. Google Scholar
Jeannerod, M. The representing brain-neural correlates of motor integration and imagery. Behav Brain Sci 1994;17:187–202. CrossRefGoogle Scholar
Helmholtz, H. Science and culture: popular and philosophical essays. Chicago: Univ of Chicago Press, 1995. Google Scholar
Blakemore, SJ, Wolpert, DM, Frith, CD. Central cancellation of self produced tickle sensation. Nat Neurosci 1998;1:635–640. CrossRefGoogle ScholarPubMed
Jeannerod, M. The cognitive neuroscience of action. Oxford: Blackwell, 1997. Google Scholar
McGonigle, DJ, Hanninen, R, Salenius, S, Hari, R, Frackowiak, SJ, Frith, CD. Whose arm is it anyway? An f-MRI case study of supernumerary phantom limb. Brain 2002;125:1265–1274. CrossRefGoogle Scholar
Bentall, RP, Slade, PD. Reality testing and auditory hallucinations: a signal detection analysis. Br J Clin Psychol 1985;24:213–222. CrossRefGoogle ScholarPubMed
Frith, CD, Done, DJ. Towards a neuropsychology of schizophrenia. Br J Psychiatr 1988;153:437–443. CrossRefGoogle ScholarPubMed
Aleman, A, Böcker, KBE, Hijman, R, Kahn, RS, De Haan, EHF. Hallucinations in schizophrenia: distorted balance between imagery and perception? Schizophr Res 2002;57:315–316. CrossRefGoogle Scholar
Behrendt, RP. Underconstrained perception: a theoretical approach to the nature and function of verbal hallucinations. Compr Psychiatry 1998;39:236–248. CrossRefGoogle Scholar
Grossberg, S. How hallucinations may arise from brain mechanisms of learning, attention, and volition. J Int Neuropsychol Soc 2000;6:583–592. CrossRefGoogle ScholarPubMed
Johnson, MK, Raye, CL. Reality monitoring. Psychol Rev 1981;88:67–85. CrossRefGoogle Scholar
Aleman, A, Bocker, KBE, Hijman, R, De Haan, EHF, Kahn, RS. Cognitive basis of hallucinations in schizophrenia: role of top-down information processing. Schizophr Res 2003;64:175–185. CrossRefGoogle ScholarPubMed
Spengos, K, Tsivgoulis, G, Papadimitriou, GN, Spengos, M. Magnetic resonance imaging findings in a case of stroke-related peduncular hallucinosis. Acta Neuropsychiatrica 2006;18:230–231. CrossRefGoogle Scholar