Posterior Alien Hand Syndrome in a Patient with Parieto-Occipital Infarction: A Rare Presentation Mimicking Anterior Variant Features

Abstract Background Alien hand syndrome (AHS) is a rare condition characterized by involuntary movements of a limb that the patient perceives as alien and is usually associated with anterior or posterior brain lesions. This case involved a unique posterior AHS overlapping with the anterior form. Case Presentation: A 76-year-old male patient presented to the emergency department with confusion agitation and involuntary movement of the right arm subsequent to a fall. His medical history included recurrent pulmonary embolism treated with edoxaban, diabetes, and hypertension. Initial CT imaging indicated chronic changes; nevertheless, within 24 hours, his symptoms intensified, and subsequent imaging demonstrated a left posterior circulation infarct (PCA). His uncontrollable arm movements resulted in a diagnosis of posterior alien hand syndrome (AHS). Management and outcome: Management involved the use of aspirin, temporary cessation of edoxaban, and agitation management with quetiapine. After confirming the stability of the infarction, edoxaban was reintroduced. This case underscores the difficulties in treating AHS and anticoagulation in a complicated stroke scenario. Conclusion This case underscores the varied manifestations of AHS variations, indicating a complicated interaction among anatomical regions. A multidisciplinary approach is crucial for the management of AHS, especially in instances with overlapping features.