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

Abstract

Rationale: This paper reports on a chronic hemiparetic stroke patient who showed delayed gait recovery due to resolution of limb-kinetic apraxia (LKA). Patient concerns: A 49-year-old man underwent comprehensive rehabilitation at a local rehabilitation hospital since 3 weeks after spontaneous intracerebral haemorrhage. However, he could not walk independently because of severe motor weakness in his right leg until 19 months after the onset. Diagnosis: At the beginning of rehabilitation at our hospital (19 months after onset), we thought that he had the neurological potential to walk independently because the unaffected (right) corticospinal tract and corticoreticulospinal tract were closely related to the gait potential, representing intact integrities. As a result, we assumed that the severe motor weakness in the right leg was mainly ascribed to LKA. Interventions: At our hospital, he underwent comprehensive rehabilitation including increased doses of dopaminergic drugs (pramipexole, ropinirole, amantadine, and carbidopa/levodopa). Outcomes: After 10 days to our hospital, he could walk independently on an even floor with verbal supervision, concurrent with motor recovery of the right leg. After 24 days after hospital admission, he could walk independently on an even floor. Lessons: We believe that the resolution of LKA in his right leg by the administration of adequate doses of dopaminergic drugs was the main reason for the delayed gait recovery in this patient. The results suggest the importance of detecting the neurological potential for gait ability of a stroke patient who cannot walk after the gait recovery phase and the causes of gait inability for individual patients.

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

“…This article reviewed 5 DTT-based studies on LKA-related neural tracts in stroke patients [ 2 , 7 , 15 , 16 , 23 ]. These reviewed studies suggest that DTT could be a useful diagnostic tool for LKA along with previous diagnostic tools, such as brain MRI and TMS.…”

“…Recently, Jang and Byun (2022) reported a chronic stroke patient who showed delayed gait recovery and improved LKA through 24 days of rehabilitation that started 19 months after onset [ 16 ]. A 49-year-old man was diagnosed with a spontaneous intracerebral hemorrhage in the left basal ganglia.…”

“…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 ].…”

“…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 ]. Nevertheless, a few recent studies reported that the corticofugal tract (CFT) from the secondary motor area is strongly overlapped with the CST at the subcortical level [ 24 – 26 ].…”

“…This review presents the findings from recent studies on the role of DTT in the diagnosis of LKA in stroke patients ( Table 1 ) [ 2 , 7 , 15 , 16 , 23 ].…”