Jang Sung Ho, Seo You Sung
Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University 317-1, Daemyungdong, Namku, Taegu, Republic of Korea.
Medicine (Baltimore). 2020 Dec 4;99(49):e22452. doi: 10.1097/MD.0000000000022452.
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.
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.
The patient diagnosed complete monoplegia due to LKA after traumatic brain injury.
He underwent conservative management for TBI followed by rehabilitation at approximately 2 months after onset.
At 32-month after onset, weakness on left arm (Manual Muscle Test [MMT]:0) and partial weakness of left leg (MMT:3).
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.
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.
肢体运动性失用症（LKA）是一种运动执行障碍，是二级运动区皮质传出束（CFTs）损伤的结果。我们报告了一名因LKA导致创伤性脑损伤（TBI）和完全性单瘫的患者，该患者主要归因于使用弥散张量纤维束成像技术显示的二级运动区CFT损伤。
一名35岁男性骑摩托车时被汽车从侧面撞击，摔倒在地导致头部直接受伤。他昏迷了约1个月，事故后经历了持续性创伤后遗忘。患者格拉斯哥昏迷量表评分为3分，自TBI发病以来表现为四肢瘫，包括左臂完全性单瘫。
该患者被诊断为创伤性脑损伤后因LKA导致的完全性单瘫。
他接受了TBI的保守治疗，发病后约2个月开始康复治疗。
发病32个月后，左臂无力（徒手肌力测试[MMT]：0级），左腿部分无力（MMT：3级）。
左上肢肌电图和神经传导研究结果正常。拇短展肌（APB）的运动诱发电位值为：右侧APB潜伏期22.3毫秒，波幅1.6毫伏；左侧APB潜伏期22.8毫秒，波幅1.5毫伏。在给予多巴胺能药物改善LKA 2周后，左臂无力恢复到可抗重力运动的水平（MMT：3级）。发病32个月后的弥散张量纤维束成像显示右侧皮质脊髓束在脑桥水平中断，左侧皮质脊髓束在皮质下白质部分撕裂。此外，来自辅助运动区的左侧CFT在皮质下白质部分撕裂。
一名TBI后完全性单瘫患者证实了因左侧辅助运动区 - CFT损伤导致的LKA。准确诊断LKA对于成功康复很重要，因为已知LKA对多巴胺能药物治疗有反应。
