Limb apraxia in a patient with cerebral infarct: Diffusion tensor tractography study

Kim²,

Seo³

2018

Self Cite

Rationale:We report on a patient with traumatic brain injury who showed motor recovery concurrent with recovery of injured corticofugal tracts (CFTs), diagnosed by diffusion tensor tractography (DTT).Patient concerns:Four weeks after onset, when the patient started rehabilitation, he showed severe weakness of both upper and lower extremities [Motricity Index (MI, full score: 100/100): 9/30].Diagnoses:A 29-year-old male patient underwent conservative management for traumatic hemorrhages in both frontal lobes and right thalamus resulting from a car accident.Interventions:The patient participated in a comprehensive rehabilitative management program, including movement therapy, dopaminergic drugs for improvement of apraxia (pramipexole: 2.5mg, amantadine: 300mg, ropinirole: 0.75 mg, and levodopa: 500mg), and neuromuscular electrical stimulation therapy of the right elbow extensors, finger extensors, both knee extensors, and ankle dorsiflexors.Outcomes:After 2 months’ intensive rehabilitation, his motor weakness rapidly recovered to the point that he was able to move all 4 extremities against some resistance (MI: 75/75). The right supplementary motor area (SMA)-CFT showed narrowing and partial tearing in the upper portion on 1-month DTT, and became thicker on 3-month DTT. Compared to the 12 normal control subjects, the fractional anisotropy (FA) values of the right corticospinal tract and both dorsal premotor cortex-CFT were more than 1 standard deviation lower than those of normal control subjects on both 1- and 3-month DTTs.Lessons:Although the tract volume of the right SMA-CFT was more than 1 standard deviation lower than normal control subjects on 1-month DTT, it increased to within 1 standard deviation on 3-month DTT. Recovery of the injured SMA-CFT concurrent with motor recovery was demonstrated in a patient with traumatic brain injury.

Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Recovery of an injured corticofugal tract from the supplementary motor area in a patient with traumatic brain injury

Kim²,

Seo³

2018

Self Cite

“…On the other hand, the severe weakness of patients who showed no shoulder subluxation (group B) and preserved integrity of the affected CST (type B) at the first evaluation was ascribed to the severe limb-kinetic apraxia as well as partial injury of the CST. [ 33 34 35 36 ] Therefore, information on shoulder subluxation and the integrity of the affected CST on DTT at an early stage of stroke can be useful for differential diagnosis for accompanying limb-kinetic apraxia and pure motor weakness. Furthermore, information on the presence of limb-kinetic apraxia can provide a useful guideline for rehabilitative management because limb-kinetic apraxia can be resolved by administration of dopaminergic drugs.…”

Section: Discussionmentioning

confidence: 99%

Prediction of motor outcome by shoulder subluxation at early stage of stroke

Jing²,

Chang³

et al. 2016

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We attempted to determine whether shoulder subluxation at the early stage of stroke can predict motor outcome in relation to the corticospinal tract (CST) state on diffusion tensor tractography.Fifty-nine stroke patients with severe hemiparesis were recruited. The patients were classified according to the distance of shoulder subluxation (group A: ≥2 cm, group B: <2 cm) and the affected CST on diffusion tensor tractography at the first evaluation (CST type A—the CST was discontinued at the stroke lesion; CST type B—the integrity of the CST was preserved). Motor function of the patients was evaluated twice (first: beginning of rehabilitation—24.1 ± 16.6 days; second: discharge after first rehabilitation—58.5 ± 24.1 days) using the Medical Research Council score, Motricity Index, and Modified Brunnstrom Classification.Regarding the improvement of the Medical Research Council for the finger extensor and upper Motricity Index, the order in terms of better recovery was as follows: group B–type B, group A–type B, group B–type A, and group A–type A (P < 0.05). The distance of shoulder subluxation showed significant correlation with improvement of the finger extensor (moderate negative correlation, r = −0.37) and improvement of the Modified Brunnstrom Classification (weak negative correlation, r = −0.29) (P < 0.05).The presence of shoulder subluxation at the early stage of stroke can be a predictor of motor outcome of the affected upper extremity and the degree of shoulder subluxation can be a predictor of the motor function of the affected hand. Therefore, our results suggest that shoulder subluxation in relation to the affected CST state at the early stage of stroke can be a prognostic factor for motor outcome.

“…First, diagnosis of LKA is dependent mainly on clinical observation of movements. [ 1 , 7 , 17 – 19 ] The clinical characteristics of the left-hand movements (slow, clumsy, and mutilated) were compatible with those of LKA (awkward, clumsy, coarse, mutilated pattern of execution of simple movements that are confined mainly to movements of the affected hand). However, because the patient showed normal cognition for motor performance and a normal result on the ideomotor apraxia test, we were able to rule out ideational and ideomotor apraxia.…”

Section: Discussionmentioning

confidence: 86%

Limb-kinetic apraxia in a patient with mild traumatic brain injury

Seo²

2017

Self Cite

Rationale:We report on a patient who developed limb-kinetic apraxia (LKA) due to an injured corticofugal tract (CFT) from the secondary motor area following mild traumatic brain injury (TBI), demonstrated on diffusion tensor tractography (DTT).Patient concerns:She was struck in the right leg by a sedan at a crosswalk and fell to the ground. She lost consciousness and experienced post-traumatic amnesia for approximately ten minutes. She was obliged to wear a cast for a left humerus fracture for two months, and she found she could not move her left hand quickly with intention after removal of the cast; consequently her left hand was almost non-functional. When she visited the rehabilitation department of a university hospital two years after the crash, she had mild weakness of the left upper extremity (manual muscle test: 4/5). However, the movements of the left hand were slow, clumsy, and mutilated when executing grasp-release movements of her left hand.Diagnoses:A 44-year-old female suffered head trauma resulting from a pedestrian car accident.Interventions:When she extended all her left fingers, it took approximately eight seconds at her fastest speed to perform the pattern extending from the thumb to little finger sequentially.Outcomes:On two-year DTT, narrowing and partial tearing was observed in the right supplementary motor area (SMA)-CFT.Lessons:Injury of the right SMA-CFT was demonstrated in a patient with LKA in a hand following mild TBI. Our results stress the need to evaluate the CFTs from the secondary motor area for patients with unexplained motor execution problems following mild TBI.