J Korean Med Sci.  2011 Jun;26(6):844-847. 10.3346/jkms.2011.26.6.844.

Atypical Supernumerary Phantom Limb and Phantom Limb Pain in Two Patients with Pontine Hemorrhage

• Yoo SD
• Kim DH
• Jeong YS
• Chon J
• Bark J

• KMID: 1785976
• DOI: http://doi.org/10.3346/jkms.2011.26.6.844

Abstract

Phantom limbs are usually observed after amputation of extremities. In patients after a stroke, a similar but rarely occurring phenomenon consisting of the patient experiencing the presence of an additional limb has been described. This phenomenon, generally called supernumerary phantom limb (SPL), may be caused by lesions in the right or left cerebral hemisphere, but has been predominantly reported in patients who have had a right hemispheric stroke. We report two cases of atypical SPL and phantom limb pain (PLP) after pontine hemorrhage. The patients were treated conservatively and their symptoms lasted more than 1 month. This is the first report of SPLs after left pontine hemorrhage, and phantom perception and pain lasted longer than those in previously observed cases. Our results indicate that SPL may be more common than reported; therefore, thorough examinations are essential for the care of stroke patients.

Keyword

Supernumerary Phantom Limb; Phantom Limb Pain; Stroke

MeSH Terms

Cerebral Hemorrhage/*complications
Cerebral Infarction/complications
Female
Humans
Male
Middle Aged
Pain/etiology
Phantom Limb/*diagnosis/etiology/therapy
Psychomotor Performance/physiology
Stroke/complications
Tomography, X-Ray Computed

Figure

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  Fig. 1 Initial and follow-up computed tomography of the brain. (A) CT scans of the brain at the time of the first admission showed the left pontine area of hemorrhage measuring 1.0 × 2.5 cm. (B) CT scans of the brain at 2 months after the first admission showed encephalomalatic change of the left pontine area.

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  Fig. 2 Self-representation of the supernumerary limb drawn by the patient. The abnormal upper limb emerged upside the original limb, but the abnormal lower limb was not clearly drawn.

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  Fig. 3 Initial and follow-up CT scans of the brain. (A) CT scans at the time of the first admission showed the left pontine area hemorrhage of 1.8 × 1.8 cm in size. (B) CT scans of the brain at 20 days after the first admission showed that the hematoma had been evacuated.

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