A 62-year-old right-handed man developed pontine hemorrhage at 58 years of age. He presented with lucidity, good communication (mild dysarthria), severe right hemiplegia, and mild left ataxia. The patient believed that he had another right arm (a supernumerary phantom limb, or SPL) originating from the paretic arm at the level of the shoulder, and that this arm could be moved freely. We evaluated the characteristics of the controllable phantom limb using a self-portrait task while resting, exercise of the SPL, and the movement of the paralyzed limb. At rest, the SPL was present at the same position as the paralyzed limbs. On the other hand, at the time of SPL movement, the phantom limb was present at a position distant from the paralyzed limb (the separation of the limbs occurred at the moment when the SPL exceeded the voluntary movable range of the paralyzed limb). The patient was unable to perform different movements with the SPL and the paralyzed limb and reported feeling that the SPL was pulling the paralyzed limb. These results suggest that the voluntary movements of the paralyzed limbs and the SPL are to a certain extent performed using common information for intentional movement. As yet, no cases of controllable pontine hemorrhage prolonging for more than four years have been reported. Thus, this case report is considered to be important for understanding the pathogenesis of SPL.
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