Ipsilateral Tremor-Like Grasp Reaction in a Patient With Ischemic Stroke

Reports of involuntary ipsilateral movements after a stroke are rare, and none have described a patient with both an instinctive grasp reaction and tremor-like movement ipsilateral to the acute stroke lesion. We here report such a patient. A 76-year-old right-handed woman with a past history of left thalamic hemorrhage developed left hemiparesis, an instinctive grasp reaction, and a peculiar involuntary movement of her right arm. This involuntary movement was stereotyped and sometimes rhythmical, with a groping or picking-like action. The lesion responsible for her motor deficits was a broad infarct in the right internal carotid artery territory. We suggest that her characteristic involuntary tremor-like movement was a variation of the instinctive grasp reaction caused by an ipsilateral ischemic lesion that included the frontal lobe. We illustrate her movements with a video, Supplemental Digital Content 1, http://links.lww.com/CBN/A65.