Brain water intoxication and CT hypolucencies in ovarian hyperstimulation syndrome complicating gametes intrafallopian transfer (GIFT) and tubal pregnancy.

He had no additional neurological symptoms during the next 13 months. He has stopped smoking and drinking alcohol. Arterial blood pressure and the lipid profile have returned to normal. Leiguarda et al ' reported four patients with frontal and parietal lesions in which abnormal complex movements akin to the alien hand syndrome were present in brief episodes, sometimes followed by focal and generalised seizures. Our patient was very different, having multiple risk factors for stroke, Leriche syndrome, and three previous cerebrovascular lesions. The described episode had an abrupt onset and gradual recovery, featuring some of the most typical symptoms of reversible ischaemic dysfunction. The pattern of abnormal movements and the pronounced leg weakness in our patient is suggestive of damage to the medial frontal lobe.23 The typical syndrome after midline lesions has a different presentation, with much intermanual conflict,3 the abnormal behaviour of the affected hand always being triggered by volitional movements of the normal hand.4 Sensory changes have already been described in patients with alien hand syndrome.' I We speculate whether the ipsilateral hypaesthesia (thalamic?) somehow contributed to the pattern of abnormal movements of the arm, as in patients with parietooccipital lesions.5 Reversible reduction of blood flow to the medial frontal cortex responsible for the formation of motor programmes (plus thalamoparietal region?) should now be regarded as another cause for the transient alien hand phenomenon.