Cortex In Press, Journal Pre-proof doi.org/10.1016/j.cortex.2023.08.010

Illusory hand movements in the absence of asomatognosia, spatial neglect and anosognosia for hemiplegia

Illusory limb movements (ILMs) represent a form of confabulation, namely, an erroneous statement that a person makes with apparent conviction and without the intention to deceive (Gershwind, 1965; Joseph, 1986). Patients with ILMs report having the illusion of involuntary, uncontrollable movements executed by the contralesional upper limb (Bourlon et al., 2017; Critchley, 1953), sometimes mirroring the healthy hand. Crucially, the movements do not actually occur unlike in the case of the Anarchic hand syndrome (Della Sala, 2009; Moro et al., 2015). ILMs have been typically considered as a symptom associated with body representation disorders, in particular with anosognosia for hemiplegia (AHP) (Feinberg et al., 1994), asomatognosia, and a disturbed sense of ownership (DSO) (Feinberg et al., 2000; Zampini et al., 2004; Jenkinson et al., 2018), as well as with somatosensory deficits and spatial disorders (Feinberg et al., 2000). However, the interactions between these clinical conditions remain underexplored. Here we describe a patient (BG) who reported ILMs without any relevant sign of body representation disorders, somatosensory deficits or contralesional spatial neglect. BG is an 80-year-old, right-handed woman (with 8 years of education) who sought medical attention following a right hemisphere stroke, with left motor hemiparesis, dysarthria and contralesional spatial neglect. The CT scan revealed the presence of cortico-subcortical hypodensity in the right fronto-insular cortex and internal capsule due to secondary bleeding after an ischemic stroke consequent to the occlusion of the right internal carotid artery (Figure 1A).

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