Supernumerary phantom limb without phantom limb pain in a patient with pontine haemorrhage

Supernumerary phantom limb (SPL) is an awareness of an illusory extra limb in addition to the existing limbs. This illusion can be disturbing if unrecognised. SPL due to cerebral lesions is rare but occurs in various neurological disorders, mostly right hemispheric stroke. Detailed symptom examination is crucial as SPL may be under-reported and overlooked during the acute stroke phase. This case report describes SPL without phantom limb pain after a pontine haemorrhage, and pain absence may delay SPL identification. A female patient in her mid-40s was admitted after a median pontine haemorrhage. 6 weeks post stroke, she reported an extra left arm and leg, present since stroke onset but not identified by staff. She could move the extra arm independently of the paretic arm and did not experience any pain. The extra arm disappeared weeks later as her paretic side improved.