Complete monoplegia due to limb-kinetic apraxia in a patient with traumatic brain injury

Abstract

Rationale: Limb-kinetic apraxia (LKA) is a disorder of movement execution that is a result of injury to the corticofugal tracts (CFTs) from the secondary motor area. We report on a patient with traumatic brain injury (TBI) and complete monoplegia due to LKA, which was mainly ascribed to injury of the CFT from the secondary motor area using diffusion tensor tractography. Patient concerns: A 35-year-old male was struck by a car from the side during riding an autocycle and received direct head trauma as a result of falling to ground. He lost consciousness for approximately 1 month and experienced continuous post-traumatic amnesia after the accident. The patient's Glasgow Coma Scale score was 3 and he showed quadriparesis including complete monoplegia of his left arm since the onset of TBI. Diagnoses: The patient diagnosed complete monoplegia due to LKA after traumatic brain injury. Interventions: He underwent conservative management for TBI followed by rehabilitation at approximately 2 months after onset. Outcomes: At 32-month after onset, weakness on left arm (Manual Muscle Test [MMT]:0) and partial weakness of left leg (MMT:3). Outcomes: Results of electromyography and nerve conduction studies of left extremities were normal. Motor evoked potential values obtained from the abductor pollicis brevis muscle (APB) were: right APB latency 22.3msec, amplitude 1.6mV; left APB latency 22.8msec, amplitude 1.5mV. After 2 weeks of administration of dopaminergic drugs for improvement of LKA, left arm weakness had recovered to level that permitted movement against gravity (MMT:3). Diffusion tensor tractography at 32-month after onset showed right corticospinal tract discontinuation at the pontine level and partial tearing of the left corticospinal tract at the subcortical white matter. In addition, the left CFT from the supplementary motor area showed partial tearing at the subcortical white matter. Lessons: The LKA due to injury of the left supplementary motor area-CFT was demonstrated in a patient with complete monoplegia following TBI. Accurate diagnosis of LKA is important for successful rehabilitation because LKA is known to respond to dopaminergic drug treatment.

Delayed gait recovery by resolution of limb-kinetic apraxia in a chronic hemiparetic stroke patient

“…On the other hand, the doses of dopaminergic drugs did not appear to be sufficient for resolving LKA compared to the higher doses of dopaminergic drugs prescribed in previous studies. [ 11 , 22 – 26 ] Second, he could walk without collapse of the hip joint during the stance phase of gait, even though the affected hip extensor muscles did not show sufficient muscle power to maintain the hip joint during the stance phase on physical examination, which is additional evidence of LKA. This patient did not exhibit muscle power of the affected hip joint due to LKA, even though he had sufficient muscle power to maintain the hip joint during the stance phase of gait.…”

“…[ 26 ] Several studies have reported patients who showed motor recovery by the resolution of LKA in patients with brain injury. [ 11 , 22 – 26 ] In contrast, little is known about delayed gait recovery due to LKA resolution. [ 11 ]…”

Research Progress on the Inflammatory Effects of Long Non-coding RNA in Traumatic Brain Injury

“…Traumatic Brain Injury (TBI) is the direct or indirect effect of external force on the head, causing mechanical damage to the brain tissue, and a series of secondary pathological injuries. It can have different clinical manifestations, such as changes in brain morphology, limb dysfunction ( Jang and Seo, 2020 ), endocrine changes ( Li and Sirko, 2018 ), abnormal blood coagulation ( Albert et al, 2019 ), mental disorders ( Pavlovic et al, 2019 ), and changes in consciousness. Its disability rate and death rate are the highest among limb injuries, costing hundreds of billions of dollars each year ( Rubiano et al, 2015 ).…”

Role of Diffusion Tensor Tractography in Diagnosis of Limb-Kinetic Apraxia in Stroke Patients: A Mini-Narrative Review

“…A diagnosis of LKA is clinically important because the treatment strategy differs according to whether the motor weakness is ascribed to a CST injury or LKA. In particular, recent studies reported that dopaminergic agonists are effective for improving LKA [ 2 , 12 – 19 ]. On the other hand, a precise diagnosis of LKA is often limited because it is made based on clinical observation of the movement characteristics with a confirmation of the CST state, and no specific clinical assessment tools for LKA have been developed [ 2 ].…”

“…Classically, LKA is considered based on the condition of intactness of the affected CST. However, recent studies reported that the patients who had injury of the CST presented with LKA [ 15 , 16 , 19 , 23 ]. Therefore, a precise diagnosis of LKA can be limited in patients who cannot execute movements due to severe weakness caused by the partial injury of the CST combined with LKA [ 15 , 16 , 19 , 23 ].…”